PMC10320071_01
A: MRI Brain w/wo Contrast: Diffusion restricting lesions in right frontal lobe with FLAIR signal abnormality in the right basal ganglia and anterior limb of internal capsule and associated small foci of petechial hemorrhage. Associated local mass effect with sulcal effacement, partial effacement of right lateral ventricle, and minimal right-to-left midline shift without pathologic intracranial enhancement. B: New diffusion restricting lesions in left basal ganglia. Marked progression of right frontal lobe cytotoxic and vasogenic edema with worse leftward midline shift (9 mm), effacement of the third ventricle, obstructive hydrocephalus, and subfalcine herniation without intracranial enhancement.
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An MRI brain was obtained, promptly after, showing diffusion restriction in the right frontal lobe, see Fig. 1 A. Hypertonic saline was initiated for suspected cerebral edema and an emergent MRI brain with and without contrast was obtained, see Fig. 1B.
A: High-power magnification of brain tissue stained with Periodic Acid-Shiff (PAS) showing characteristic pauciseptate ribbon-like hyphae with wide angle branching, suggestive of mucormycosis. B: Medium-power magnification of brain tissue stained with Grocott's Methenamine Silver (GMS) showing black colored Mucor hyphae.
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Subsequently, a stereotactic-guided biopsy of his right frontal lesion was performed and sent for pathologic analysis, see Fig. 2.