A rare case of aggressive invasive fungal sinusitis with multidrug resistant Pseudomonas aeruginosa co-infection in immunocompromised: a therapeutic challenge

Mucormycosis is known to be rapidly progressing and fulminant fungal infection which has the ability to cause significant morbidity and mortality, especially in immunocompromised patients. Pseudomonas aeruginosa commonly co-isolated bacterial species from chronic wounds are likely to interact and compete with Mucorales spores.We report a 70 years old female who presented to us initially with left facial swelling with a cheek ulcer. She had initially denied the necessary investigations but later presented to us with flared up symptoms. She was a known case of type 2 diabetes mellitus, hypothyroidism and dilated cardiomyopathy on medication with permanent pacemaker implant. She was found to have left maxillary mucormycosis with left sided cheek wound having superinfection with Pseudomonas aeruginosa. Patient was started on injection Amphotericin B (lipophilic) and injection colistin with surgical debridement of the wound. Left Caldwell-Luc surgery with left inferior meatal antrostomy was performed for clearing fungal debris in left maxillary sinus. The purpose behind this paper is to highlight the need of early detection and aggressive management for successful management of mucormycosis.