� This PDF is available for free download from a site hosted by Medknow Publications (www.medknow.com). www.jpgmonline.com Case Report Mucormycosis isolated from perilymphatic tissue: Mucormycosis isolated from perilymphatic tissue: Mucormycosis isolated from perilymphatic tissue: Mucormycosis isolated from perilymphatic tissue: Mucormycosis isolated from perilymphatic tissue: An unusual presentation An unusual presentation An unusual presentation An unusual presentation An unusual presentation Chacko B, Ananthakrishna R, Vasuki Z, Thambu SD, Nair S* swelling in the cervical region. We present this case report to examinations were normal. There was no evidence of meningeal Departments of ABSTRACT ABSTRACT ABSTRACT ABSTRACT ABSTRACT Medicine and We present a rare case of a patient who presented with atypical cranial nerve palsies, with subsequent *Pathology, Christian Medical College, isolation of mucormycosis from an upper neck subcutaneous swelling. This is an unusual initial site of isolation Vellore, India of mucormycosis. We believe that this should be considered among the differentials when a diabetic or immunosupressed patient presents with cervical lymphadenopathy and cranial nerve palsies. Correspondence: Thambu David, thambu@cmcvellore.ac.in : 28-05-05 Review completed : 23-09-05 : 29-03-06 : J Postgrad Med 2006;52:294-5 KEY WORDS: Cervical swelling, facial cellulitis, fungal infection, mucormycosis ucormycosis is an aggressive, opportunistic infection with a course of antibiotics following which the swelling caused by fungi in the class of phycomycetes, first decreased but the neurological deficits and headache described in 1885 by Paltauf. [1] This typically originates in the persisted. He was then referred to our hospital for further nasal or oral mucosa, spreads to the paranasal sinuses and enters evaluation. the orbit via the ethmoid and maxillary sinuses or via the nasolacrimal duct. [2] It presents most frequently in On examination, he was found to have a small 1 x 1 cm soft immunocompromised patients, but can occur in healthy non-tender subcutaneous nodule in the left upper deep cervical patients in the presence of often insignificant trauma. [3] region. He did not have facial swelling or sinus tenderness. Diagnosis involves biopsy of affected sites-most commonly rhino cerebral, gastrointestinal and the lungs and molecular Examination of central nervous system revealed evidence of detection assays. [4,5] In the following case, we report a very fifth and seventh lower motor cranial nerve palsies; higher atypical site of isolation of mucormycosis from a subcutaneous mental functions, fundus, motor, sensory and cerebellar E-mail: Received Accepted PubMed ID M suggest to clinicians that in a diabetic with cranial nerve palsies, even in the presence of normal sinuses and nasopharynx, mucormycosis needs to be considered as an important differential diagnosis and also how bacterial infections and subsequent antimicrobial therapy can increase the risk of developing this infection. Case History A 40-year-old man, a diabetic for four years came with a history of left-sided facial and neck swelling with pain a month prior to admission. This was followed two days later by left- sided facial weakness and decreased sensation over the same area and associated holocranial headache. There was no history of trauma, fever or features to suggest raised intracranial tension. He was treated by a local practitioner irritation, proptosis or ophthalmoplegia. Rest of the systemic examination was normal. At this point of time, the diagnosis considered was polyneuritis cranialis. The differential diagnosis considered included chronic meningitis due to tuberculosis or herpes zoster, metastasis due to nasopharyngeal carcinoma or lymphoma, demyelinating diseases, pachymeningitis and facial cellulitis with involvement of the peripheral components of the fifth and seventh nerves. Investigations including cerebrospinal fluid cell counts, biochemical parameters, human immunodeficiency virus serology and cerebrospinal fluid cytology for malignant cells were negative. Blood sugar on admission was 300 mg/dl with no ketoacidosis. � 294 J Postgrad Med October 2006 Vol 52 Issue 4