Management challenges of postpartum rhinocerebral mucormycosis following spontaneous vaginal delivery in a resource-constraint setting: A case report and review of literature.

INTRODUCTION AND IMPORTANCE

Rhinocerebral mucormycosis (RM) is a rare and severe condition caused by filamentous fungi, characterized by infection of the nose, paranasal sinuses, and brain. It is the most common and fatal clinical form of mucormycosis, accounting for 50 % of reported cases. RM is seldom reported during the postpartum period. This case report presents a rare instance of RM following childbirth and reviews the most recent literature, highlighting the limited cases documented globally and even fewer within Africa. The aim is to contribute to the existing body of knowledge and provide guidance for clinicians managing similar cases. Notably, this is the first case report to describe this rare condition postpartum in Sub-Saharan Africa, specifically in Tanzania.

CASE PRESENTATION

In this case report from Northern Tanzania, we report a patient who was diagnosed with rhinocerebral mucormycosis following spontaneous normal delivery. A 34-year- old female presenting with a history of severe headache for 3 weeks, associated with blurry vision and later on completely loss of vision, dizziness and generalized body weakness. A Computed tomography scan (CT) of the head revealed a hypodense lesion of the frontal lobe with an extension compressing the optic chiasm. Magnetic Resonance Imaging (MRI) of the brain revealed hyperintensities in the frontal lobe, thalamus, periorbital regions and nasal sinuses. Treatment was stopped due to an acute kidney injury and the patient self-discharged against medical advice. Since, the patient has not returned for follow up.

CLINICAL DISCUSSION

In this report, we discuss the rarity of this condition, the literature surrounding similar reports, and the many challenges that arise in the management of rhinocerebral mucormycosis especially in limited resource settings. Currently, reports in the literature are limited. A greater evidence base is required to support the development of effective treatments which would further improve patient outcomes.

CONCLUSION

Rhinocerebral mucormycosis is potentially fatal disease which progresses rapidly. Early detection and prompt treatment are critical for survival. Antifungal therapy in combination with intensive surgical debridement facilitates improved outcomes for patients. The incidence of rhinocerebral mucormycosis cases in Tanzania has not been studied extensively. More studies are required with specific focus on patients with high risk underlying conditions such diabetes, and hematological malignancies.