IFIs are ‘presence of fungal elements either as molds or yeast in deep tissue biopsy or needle aspirates that is confirmed on culture and histopathological examination. Invasive fungal infections (IFI) have significantly increased due to advances in medical care in the ‘at risk’ immune compromised population. Diagnosis of IFIs is extremely challenging, because current diagnostic methods are not sufficiently sensitive or specific and results are often available too late to be clinically useful. Here we report a case of Invasive Mucormycosis, successfully managed using multidisciplinary approach. Three months old male child, presented with persisting fever unresponsive to ususal line of management. Child was severely malnourished with bilateral pneumonia with right sided hemiparesis and convulsions. Baby had excoriated skin lesions around nasal alae, shrunken left eye, large palatal perforation, oral thrush, nasal crusting. MRI brain showed large left parietal lobe abscess. Ophthalmological examination revealed left eye exposure keratitis with optic atrophy and old central retinal artery occlusion (CRAO). Child was given antifungal in the form of Liposomal Amphotericin B in addition to Antibiotics, IV fluids and Anticonvulsants. Brain abscess was drained and palatal perforation was debrided. Pus culture from nasal tissue grew aseptate filamentous fungal elements of Mucor. Lymphocyte subset assay suggested subnormal CD 19, CD3/CD4 and NK cell levels. Child responded well to Liposomal amphotericin B. On discharge child was vitally stable, had gained weight, healed skin lesions with no respiratory complaints. Was advised physiotherapy for residual paralysis and plastic surgery for residual palatal perforation. Malnutrition in the child, altered immunological status of the child, relatively nonspecific, multi systemic symptoms and relatively limited sensitivity and specificity of diganostic tests proved challenging in the management of this case.
