Authors: Noura Al Nuaimi , Aqeel Saleem , Asad Khan , Ali Al Hassani , Zaid Al Hassani , Ahmed A Hammadi

Abstract

Background: Isolated cerebral mucormycosis is a rare, life-threatening infection, usually occurring in immunocompromised hosts but also reported in people with intravenous drug use, with a predilection for the basal ganglia.

Case Presentation: A 30-year-old previously healthy man with a history of intravenous drug use presented with new-onset generalized seizures, altered mental status, and left-sided hemiplegia. Magnetic resonance imaging showed a 4.4 × 4.3 × 5.1 cm ring-enhancing mass in the right basal ganglia with extension into the thalamus and temporal lobe and mild midline shift. Stereotactic biopsy with conservative debulking revealed a fungal abscess; Gomori methenamine silver staining demonstrated broad pauci-septate hyphae with irregular right-angle branching, supporting a diagnosis of cerebral mucormycosis. He was treated with liposomal amphotericin B and isavuconazole, followed by prolonged oral isavuconazole. Complete excision was not feasible because of the deep lesion location.

Conclusion: Follow-up magnetic resonance imaging at 16 weeks showed reduction in lesion size and edema with partial neurologic improvement, although residual left-sided weakness persisted. This case highlights the need to consider isolated cerebral mucormycosis in basal ganglia lesions in patients with intravenous drug use, even without traditional immunosuppressive risk factors. Early tissue diagnosis, prompt antifungal therapy, and multidisciplinary surgical assessment are essential, particularly when complete resection carries high risk.

Keywords: Mucormycosis, basal ganglia, cerebral infection, intravenous drug use, amphotericin B, isavuconazole, central nervous system fungal infection.