Published: 2021-03-24

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

Debaditya Basu, Abhijit Kumar, Ajay Gupta, Binayak Baruah, Alok Kumar, Nibedita Mishra


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.


Mucormycosis, Pseudomonas aeruginosa, Early diagnosis, Immunocompromised, Chronic wound, Aggressive management

Full Text:



DeNegre AA, Ndeffo Mbah ML, Myers K, Fefferman NH. Emergence of antibiotic resistance in immunocompromised host populations: A case study of emerging antibiotic resistant tuberculosis in AIDS patients. PloS one. 2019;14(2):e0212969.

Nikaido H. Multidrug resistance in bacteria. Annual review of biochemistry. 2009;78:119-46.

Sen P, Kapila R, Chmel H, Armstrong DA, Louria DB. Superinfection: another look. The American journal of medicine. 1982;73(5):706-18.

Dropulic LK, Lederman HM. Overview of infections in the immunocompromised host. Diagnostic Microbiology of the Immunocompromised Host. 2016;15:1-50.

Bouza E, Munoz P, Guinea J. Mucormycosis: an emerging disease?. Clinical Microbiology and Infection. 2006;12:7-23.

Ibrahim AS, Kontoyiannis DP. Update on Mucormycosis pathogenesis. Current opinion in infectious diseases. 2013;26(6):508.

Reid G, Lynch III JP, Fishbein MC, Clark NM. Mucormycosis. InSeminars in respiratory and critical care medicine. Thieme Medical Publishers. 2020;41(1):99-114.

Gamaletsou MN, Sipsas NV, Roilides E, Walsh TJ. Rhino-orbital-cerebral Mucormycosis. Current Infect Dis Reports. 2012;14(4):423-34.

Peterson KL, Wang M, Canalis RF, Abemayor E. Rhinocerebral Mucormycosis: evolution of the disease and treatment options. The Laryngoscope. 1997;107(7):855-62.

Mignogna MD, Fortuna G, Leuci S, Adamo D, Ruoppo E, Siano M et al. Mucormycosis in immunocompetent patients: a case-series of patients with maxillary sinus involvement and a critical review of the literature. Int J Infectious Diseases. 2011;15(8):e533-40.

Strateva T, Yordanov D. Pseudomonas aeruginosa–a phenomenon of bacterial resistance. J Med Microbiol. 2009;58(9):1133-48.

Lyczak JB, Cannon CL, Pier GB. Establishment of Pseudomonas aeruginosa infection: lessons from a versatile opportunist. Microbes Infection. 2000;2(9):1051-60.

Alhazmi A. Pseudomonas aeruginosa-pathogenesis and pathogenic mechanisms. Int J Biol. 2015;7(2):44.

Kousser C, Clark C, Sherrington S, Voelz K, Hall RA. Pseudomonas aeruginosa inhibits Rhizopus microsporus germination through sequestration of free environmental iron. Sci Reports. 2019;9(1):1-4.

Caselli D, Cesaro S, Ziino O, Zanazzo G, Manicone R, Livadiotti S et al. Multidrug resistant Pseudomonas aeruginosa infection in children undergoing chemotherapy and hematopoietic stem cell transplantation. haematologica. 2010;95(9):1612-5.

Driscoll JA, Brody SL, Kollef MH. The epidemiology, pathogenesis and treatment of Pseudomonas aeruginosa infections. Drugs. 2007;67(3):351-68.

Smith JL, Stevens DA. Survival in cerebro-rhino-orbital zygomycosis and cavernous sinus thrombosis with combined therapy. Southern Med J. 1986;79(4):501-4.

Aggarwal P, Saxena S, Bansal V. Mucormycosis of maxillary sinus. J Oral Maxillofacial Pathol. 2007;11(2):66.

Singh VP, Bansal C, Kaintura M. Sinonasal Mucormycosis: A to Z. Indian J Otolaryngol Head Neck Surg. 2019;71(3):1962-71.

Serra R, Grande R, Butrico L, Rossi A, Settimio UF, Caroleo B et al. Chronic wound infections: the role of Pseudomonas aeruginosa and Staphylococcus aureus. Expert Review Anti-Infective Therapy. 2015;13(5):605-13.

Bassetti M, Vena A, Russo A, Croxatto A, Calandra T, Guery B. Rational approach in the management of Pseudomonas aeruginosa infections. Current opinion Infect Dis. 2018;31(6):578-86.