Fatal rhinocerebral mucormycosis in a patient with ulcerative colitis receiving azathioprine and corticosteroid

Abstract

Background and Purpose: Rhinocerebral mucormycosis is a rare fatal fungal infection
which is on a growing trend, particularly among immunocompromised patients.
Immunosuppressive drugs, including corticosteroids and antimetabolites, increase the
risk of this infection. Herein, we reported the case of fulminant rhinocerebral
mucormycosis in a patient with ulcerative colitis receiving azathioprine and
corticosteroid.
Case report: A 58-year-old woman was admitted to the hospital in a state of coma with
an extensive necrosis in her nose. She was afflicted with intestinal bleeding after 1
month of fasting and was treated with azathioprine and a high dose of prednisolone for
ulcerative colitis 2 months prior to hospital admission. The direct microscopic
examination of the necrotic tissues of the paranasal sinuses showed several non-septate
hyphae consistent with Mucorales. Culture media yielded Rhizopus species, which was
identified as Rhizopus oryzae by internal transcribed spacer polymerase chain reaction
sequencing. Despite the implementation of surgical and pharmaceutical (liposomal
amphotericin B) treatments, the patient expired after 2 weeks of admission.
Conclusion: The gastroenterologists should be aware of the adverse effect of
immunosuppressive drugs they prescribe for the treatment of inflammatory bowel
disease.