Background: Mucormycosis is an emerging global illness with significant morbidity and mortality.
Causative fungi can spread through inhalation of sporangiospores or direct inoculation through
damaged skin or mucosa in susceptible patients, especially those with impaired immune systems. Here
we report a rare occurrence of the disease in an immunocompetent infant following dengue
haemorrhagic fever, highlighting the treatment course which is the longest duration reported from Sri
Lanka so far.
Case presentation: A 4-month-old infant was admitted to the medical Intensive Care Unit (ICU) after
experiencing dengue haemorrhagic fever, which was complicated by multi-organ dysfunction and
required intubation. After recovery, he was found to have a necrotic lesion in the palate, which was
confirmed to be mucormycosis following biopsy. Computed Tomography (CT) and Magnetic
Resonance Imaging (MRI) scans showed erosions of the hard palate and involvement of the paranasal
sinuses, orbital floor and soft palate without brain or eye lesions.
The child was started on Intravenous (IV) liposomal amphotericin B and required several
debridement surgeries. Radiological studies showed persistent active bone lesions and antifungals were
continued until radiological, mycological and clinical clearance was achieved. Intravenous
amphotericin B was given for 270+ days required central lines and was complicated by venous
thrombosis.
A palatal prosthesis was inserted until a definite palatal repair is done. The child is clinically well and
thriving. Laboratory evaluations showed normal IgG and subclasses, IgA, IgM, and IgE levels, HIV
testing was negative, Nitroblue Tetrazolium Test (NBT) was normal and metabolic screening was
negative.
Conclusion: Though mucormycosis usually occur in children with immunosuppression or metabolic
syndromes, it can occur in immunocompetent children, especially following a critical illness with high
lactic acid levels, as in our case. It’s important to manage these children under multi-disciplinary care
and complete treatment until there is evidence of radiological clearance to achieve better outcome.
Author(s): Hashan Pathiraja*, Rakitha Munasighe, Rasika Gunapala, Jerrad Fernando, Sandini Gunaratne,
Chethana Pemasiri, Primali Jayasekera
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