Rare case: Black fungus only in patient’s brain | Bengaluru News – Times of India

BENGALURU: A 48-year-old woman from Gauribidanur, who recovered from Covid, began showing stroke-like symptoms not long after discharge and was brought to a Bengaluru hospital where doctors found mucormycosis, commonly known as black fungus, had directly affected her brain.
Doctors say no trace of the fungus was not found in her eyes, nose or sino orbital nerve through which the fungus usually enters the body. It was present only in her brain. This was confirmed through a biopsy and tissue culture studies. Doctors say they haven’t heard of such a case, at least in Karnataka, so far.
The woman has undergone a procedure to remove fungal debris from her brain at Bhagawan Mahaveer Jain Hospital, Vasanth Nagar, and is now recovering.
Signs of stroke
The woman had tested positive on May 4 and was admitted to a Covid Care Centre in her town. She was discharged on May 11. But she soon showed signs of having suffered a stroke and was taken to a government hospital in Chikkaballapura. From there, she was shifted to Jain hospital’s non-Covid ICU on May 15 as she tested negative for the SARS-CoV2 virus.
Curiously, the woman did not present any factors associated with mucormycosis. She was not a diabetic, was not on steroids or any immunosuppressant drugs and was never treated in ICU or put on a ventilator, said Dr Sharan Srinivasan, stereotactic and functional neurosurgeon, who performed the procedure to remove the fungus.
He said during Covid treatment, the woman was on mild oxygen support, but developed trouble speaking a day prior to her discharge from the CCC. After reaching home, she developed weakness in the right side of the body.
At Jain hospital, she underwent a CT scan, suggestive of stroke, but her condition did not improve with medication. She had no fever nor face swelling. Though stroke is seen post-Covid, her case did not fit the pattern. Two days later a magnetic resonance imaging (MRI) scan showed a tumour-like mass deep in the brain.
“Her case was similar to a stroke, but though it appeared like one, the MRI showed the pattern of involvement was very unusual,” said Dr Anil Ramakrishna, neurologist, Bhagawan Mahaveer Jain hospital.
He said initially, it was not even suspected to be a case of mucormycosis. “She had an infection in the deep part of the brain called thalamus. If not for the pandemic, we may not have conducted a biopsy,” the doctors said.
The MRI reading baffled doctors. “In stroke, the affected areas show as white patches. In this case, there were white and black patches in the thalamus region,” said Dr Ramakrishna. “We thought it could be brain TB or toxoplasmosis, the central nervous system infection seen among HIV patients. We even obtained permission from the patient and conducted a HIV test. But that too was negative.”
Finally, on right path

TB was ruled out after a biopsy, which finally also put doctors on the right path. “In the tissue culture study, the fungal presence was clearly seen, confirming that it was a case of mucormycosis,” Dr Ramakrishna said.
Dr Srinivasan conducted a procedure called MRI-guided stereotactic neurosurgery, which is a technique to locate targets of surgical interest within the brain, and the infectious matter in the thalamus was extracted. “It would have been tough to reach out to the infected area, if not for this deep part procedure. We had to go 9.5cm inside the brain to remove the infectious matter,” he added.
The woman is currently on antifungal drug Liposomal Amphotericin-B, but availability of the drug is a challenge doctors are facing.

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Sagar Biswas

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