HomeAnswersDermatologymucormycosisWhat could be causing my severe facial symptoms and unexplained inflammatory response despite normal blood tests?

Can early diagnosis with CT scan, endoscopic examination, and biopsy, along with liposomal amphotericin B therapy help overcome severe fungal infections?

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The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.

Answered by

Dr. Suvash Sahu

Medically reviewed by

iCliniq medical review team

Published At October 25, 2023
Reviewed AtOctober 25, 2023

Patient's Query

Hello doctor,

I suspect I may have a rare fungal infection, such as mucormycosis. Although I am not immunocompromised, ten years ago, I suffered severe burns to my entire face from pressurized steam, fortunately leaving no scars. However, my health has slowly deteriorated since then. At the beginning of this year, I started experiencing eye problems, swelling, and sinus pain. I have been diagnosed with chronic sinusitis and am currently awaiting a CT scan to investigate a possible fungal infection, which I fear may have become invasive. My eyes and nose are terribly swollen, and I experience unbearable facial pain most of the time. Additionally, I suffer from severe neck stiffness and pain behind my ears. I seem to have an unexplained inflammatory response, particularly in my cranial area and left arm. Under UV light, I can see severe facial bruising around my sinuses and cheeks, and the area around my eyes appears black, with the condition worsening. Sometimes, I even notice my neck turning blue. Furthermore, I have observed what seems to be subcutaneous mold on my face and a fungal asteroid on my forehead. I also have lesions and sores in my mouth and appear to have an allergic reaction to anything moldy or fungal, such as garden debris.

I have sought help from medical professionals, but my current diagnosis is that I am delusional. Nevertheless, I believe my situation is critical and requires urgent and aggressive medical attention. The pain is unbearable, and I spend most of my days in bed, sleeping around 20 hours per day. Four years ago, I had a previous history of medical conditions where I was induced into a coma due to a suspected and unconfirmed, untreated infection of the membranes, accompanied by high blood pressure at times dangerously elevated. Currently, my medications include Naproxen, antihistamines, and Diazepam. In the past, I have taken Amoxicillin and Terbinafine for the same complaint. Lab tests indicate that all my blood tests are normal, except for a raised inflammatory response and yeast in saliva while being treated.

Thank you.

Answered by Dr. Suvash Sahu

Hello,

Welcome to icliniq.com.

I have read your query and concerns and examined your picture (attachments removed to protect patient's identity). Mucormycosis refers to diseases caused by fungal infections that can lead to systemic symptoms. In severe cases, it can cause infection in the facial sinuses, which may extend into the brain, and this is the most common presentation. It may present with rhinocerebral disease, characterized by one-sided, retro-orbital headache, facial pain, numbness, fever, decreased sense of smell, and nasal stuffiness, which can progress to black discharge.

Early diagnosis is crucial in cases of mucormycosis. Emergent CT scanning of the paranasal sinuses and an endoscopic examination of the nasal passages with biopsies of any suggestive lesions are necessary. The diagnosis of mucormycosis is confirmed by obtaining a biopsy specimen of the involved tissue, and frozen tissue samples should be immediately evaluated for signs of infection. Tissue should also be sent for routine pathology examination and cultures. For cutaneous disease, a skin biopsy for pathology and culture should be done. If your sample tests positive for mucormycosis, it should be treated in a tertiary referral center. Correction of any underlying abnormalities, if detected, is of paramount importance, alongside the prompt institution of Liposomal Amphotericin B therapy by the treating doctor. Based on your condition, there is suspicion for mucormycosis, and proper evaluation is necessary.

Thanks and regards.

Patient's Query

Thank you doctor for the reply,

I have also noticed a disfigured rash mainly concentrated around my eyes and face, which resembles spaghetti and fluoresces under sunlight. Additionally, I have swellings that look like thin teardrops running down the sides of my nose to the corners of my mouth. Are these symptoms also related? If this is a case of mucormycosis and I was infected almost ten years ago, does this mean I need urgent medical attention now?

Answered by Dr. Suvash Sahu

Hello,

Welcome back to icliniq.com.

I understand your concern. I think you need to wait for your CT scan report. If anything comes back positive, you must consult a nearby tertiary referral center. The symptoms you mentioned are closely related to this disease, but since your blood report is normal, which typically shows a decrease in neutrophil counts, you can wait until the CT scan report or until you experience any life-threatening events such as breathing difficulties or abnormal vital signs like pulse rate, blood pressure, or temperature.

Thank you.

Same symptoms don't mean you have the same problem. Consult a doctor now!

Dr. Suvash Sahu
Dr. Suvash Sahu

Dermatology

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