Rare case of Rhinocerebral mucormycosis in Systemic lupus erythematosus

We report a 30yr old lady with lupus nephritis who after achieving remission defaulted and presented with relapse and was restarted on IV cyclophosphamide. She developed rhinocerebroorbital zygomycosis caused by Apophysomyces elegans. This organism has been described from Indian subcontinent first and mainly is associated with traumatic cases with soil contamination at site of injury in immunocompetent patients. Overall prognosis has been good with majority surviving with surgical debridement and antifungal therapy with Amphotericin. Our patient is perhaps the first patient in whom this condition developed in association with systemic lupus erythematosus. She had a very rapid and progressive involvement leading to orbital cellulitis and sinusitis along with intracranial involvement which also led to hemmorhagic infarction of bilateral fronto-basal lobes which ended fatally. The poor prognosis compared to other cases is explainable in light of her profound immunosupressed state.