Malik A, Soofi A, Ahmad A, Kayani N.
Mucormycosis complicating Interstitial Nephritis - Two cases and brief literature review.
J Pak Med Assoc Jan ;54(6):332-4.

Fifty six year old hypertensive female presented with recent history of rapidly deteriorating renal function. She was started on dialysis. Ultrasound showed normal renal size with no obstruction. Renal biopsy revealed marked tubulo-interstitial inflammation ad extensive tubular atrophy consistent with interstitial nephritis. She was started on oral prednisolone 30mg twice daily with subsequent improvement in renal function. However, fifteen days after the start of her medication, she presented to the emergency room with headache for two days and epistaxis for one day. On physical examination, she was found to be tachycardic and febrile. She was drowsy but oriented to time, place and person with a normal neurological examination. Examination of the right nostril revealed blood clot. Complete blood count showed left shift neutrophilia. A day later she rapidly developed right ophthalmoplegia, ptosis and marked decrease in her visual acuity. MRI revealed diffuse infiltration of right retro-orbital fat with hypo/iso-intense material suggesting possibility of some fungal involvement. Nasal endoscopy showed black material in right middle turbinate which was endoscopically debrided. Her right eye and peri-orbital tissue were removed. Histopathology showed necrosis of muscle tissue along with granulomatous inflammation. Multiple broad ribbonlike fungal hyphae (mucor like) were identified. The special stain for fungus was positive. The eyeball itself was not involved by fungus. She was started on intravenous amphotericin for six weeks. She became clinically stable in the next two weeks.

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