Invasive cranial mycosis our experiences
A 50yr old male[], who had Type2 Diabetes for last 4yrs was admitted in our institute in 2009. He was very irregular with his treatment and was on indegenous medications for past few days. He had history of frontal headache, dizziness, slurred speech and weakness on left half of body. Ten days back, he became inattentive. He was in Hyperglycaemic Hyperosmolar state with septicaemia. CT scan head revealed large (5-6cm) discrete, irregular peripheral ring- enhancing necrotic lesion in right frontoparietal region of brain causing mass effect & midline shift with perifocal edema []. Neurosurgical intervention was done and 8ml of thick viscous black fluid, which was mainly caseous, was aspirated. The material was analysed. Microscopic examination revealed Langerhans giant cells with moniliform septated hyphal elements and tentative diagnosis of chronic granulomatous inflammation with super added fungal infection was made. On culture growth was observed after 1 week & morphologically classified as Rhinocladiella Mackenzie []. For the management of the case,\ninsulin infusion was given along with injectable amphotericin B and Antitubercular drugs. Despite this therapy patient's condition continued to deteriorate & he sucummed within 2 weeks of diagnosis.