Abstract Details

Title Looks like a Stroke, Acts like a Stroke, but It's More Than a Stroke: A Case of Cerebral Mucormycosis in a Patient with CLL

Topic Infections/AIDS/Prion Disease

Presentation(s) P06 - (-)

Poster/Presentation
Number 182

Objective

Background BACKGROUND: Cerebral mucormycosis can occur due to direct invasion from rhino-orbital structures or can be secondary to hematogenous spread. Risk factors for infection include diabetes, malignancy, renal disease, connective tissue disorder, liver cirrhosis or states of immunosuppression.

Design/Methods DESIGN/METHODS: Case report.

Results RESULTS: A 68 year old male with CLL was admitted to the medical ICU with a traumatic subarachnoid hemorrhage in the setting of thrombocytopenia. On hospital day 2 he became acutely aphasic and CT of the head was suggestive of ischemic stroke. Follow up MRI indicated that the lesion crossed into multiple vascular territories. Serial imaging revealed cerebral edema and impending herniation. MR spectroscopy was unable to delineate the pathology of the lesion. Surgical intervention was declined. At death, his brain was sent for autopsy. Gross inspection of the brain revealed grayish blue discoloration and histological evaluation revealed mucormycosis. There was associated thrombosis of many major cerebral blood vessels. The patient's chest x-ray prior to death was suggestive of pneumonia. Full body autopsy was declined at the time of death. Hematogenous spread is known to occur in the setting of malignancy with neutropenia, as is suspected in this case. The fungus often exhibits angiocentric growth, and can cause thrombosis that ultimately leads to infarction.

Conclusions CONCLUSIONS: Cerebral mucormycosis is most often fatal and diagnosis is often difficult. This case represents a unique presentation mimicking the acute focal deficits of a stroke marked by rapid development of cerebral edema and death.

Authors/Disclosures
David M. Ermak, DO (Penn State Hershey Medical Center) PRESENTER	Dr. Ermak has nothing to disclose.
Sangam G. Kanekar, MD, DNB (Penn State Hershey Medical Center)	No disclosure on file
Max R. Lowden, MD, FAAN (Penn State Hershey Medical Center)	Dr. Lowden has nothing to disclose.
	No disclosure on file
Xavier Montalban, MD, PhD, FAAN (Vall Hebron University Hospital-Multiple Sclerosis Centre of Catalonia)	The institution of Dr. Montalban has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Biogen. The institution of Dr. Montalban has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Merck/ EMD Serono. The institution of Dr. Montalban has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Novartis. The institution of Dr. Montalban has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Teva. The institution of Dr. Montalban has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Hoffmann-La Roche. The institution of Dr. Montalban has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Actelion/ Janssen Pharmaceuticals. The institution of Dr. Montalban has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for BMS/ Celgene. The institution of Dr. Montalban has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Sanofi/ Genzyme. The institution of Dr. Montalban has received personal compensation in the range of $500-$4,999 for serving as a Consultant for BIAL PD. The institution of Dr. Montalban has received personal compensation in the range of $500-$4,999 for serving as a Consultant for PeerVoice. The institution of Dr. Montalban has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Samsung Biosys. The institution of Dr. Montalban has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Zenas BioPharma. Dr. Montalban has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Actelion/ Janssen Pharmaceuticals. Dr. Montalban has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Biogen. Dr. Montalban has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for BMS/ Celgene. Dr. Montalban has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Merck/ EMD Serono. Dr. Montalban has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Novartis. Dr. Montalban has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Hoffmann-La Roche. Dr. Montalban has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Sanofi-Genzyme. The institution of Dr. Montalban has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Immunic Therapeutics. The institution of Dr. Montalban has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Viatris/ Mylan. The institution of Dr. Montalban has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Sandoz. The institution of Dr. Montalban has received research support from Biogen. The institution of Dr. Montalban has received research support from Hoffmann-La Roche. The institution of Dr. Montalban has received research support from Sanofi/ Genzyme. The institution of Dr. Montalban has received research support from Merck/ EMD Serono. The institution of Dr. Montalban has received research support from Novartis. The institution of Dr. Montalban has received research support from Teva Pharmaceuticals. The institution of Dr. Montalban has received research support from Actelion/ Janssen Pharmaceuticals. The institution of Dr. Montalban has received research support from BMS/ Celgene.
	No disclosure on file

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