1. PATIENT PRESENTATION
A 62‐year‐old male with no known medical history presented complaining of a black lesion on his nose that appeared 1 week prior upon waking up in the morning. Physical examination revealed a severely necrotic lesion expanding superiorly to inferiorly that perforated the septum (Figure 1). There was also an abducens nerve palsy that involved the left eye, and a Bell's palsy that involved the left side of the face. Labs were remarkable for previously undiagnosed diabetes with a glucose of 474. Computed tomography (CT) maxillofacial exam was performed to determine the extent of the lesion (Figure 2).
FIGURE 1.
Black eschar sign, which is the hallmark of mucormycosis infection.
FIGURE 2.
Axial computed tomography of maxillofacial demonstrating sub Q emphysema and maxillary sinus erosion (black arrow).
2. DIAGNOSIS
2.1. Rhinocerebral mucormycosis
Upon seeing the result of the glucose together with the physical examination, rhinocerebral mucormycosis was immediately suggested by the attending physician. CT maxillofacial showed extensive necrosis of soft tissue and obliteration of bone. Immediate consultation to the appropriate specialists (ear, nose and throat; oral and maxillofacial surgery) led to a prompt tissue biopsy confirming the diagnosis.
Rhinocerebral mucormycosis is a rare opportunistic filamentous fungi infection. It most often involves the nose, paranasal sinuses, and brain. It generally appears in immunocompromised individuals and is associated with diabetes, prolonged steroid use, HIV, severe burns, organ transplants, etc. 1 The infection is aggressive and rapid and requires early intervention to prevent death or permanent neurological deficits. Management involves immediate and prolonged administration of amphotericin B for 4–6 weeks with a goal of 1 mg/kg/day. Surgical debridement and resection of infected tissues are also indicated. 2
Grow J, Rivera S, Brown JM, Kifer S. Male with black facial lesion. JACEP Open. 2023;4:e12965. 10.1002/emp2.12965
REFERENCES
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