- Rhinocerebral mucormycosis: five cases and a literature review
- C. Mbarek, S. Zribi, K. Khamassi, I. Hariga, H. Ouni, M. Ben Amor, O. Ben Gamra and A. El Khedim
- D epartment of Otorhinolaryngology-Head and Neck Surgery, Habib Thameur Hospital, Tunis, Tunisia
- Mucormycosis; fungal infection; diabetes mellitus; antifungal drugs
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- Rhinocerebral mucormycosis: five cases and a literature review. Objective: In this retrospective study, we
describe our experience in the diagnosis and management of rhinocerebral mucormycosis (RCM), a rapidly lethal
Methodology: Between 1997 and 2007, five patients hospitalized for suspicion of RCM. Computed tomography was
performed in all cases, and diagnosis was confirmed after anatomopathological or mycological examination.All patients
underwent medical and surgical treatment. Follow-up was clinical and radiological with a mean period of 17 months.
Results: All patients were diabetic. Exophthalmia, rhinorrhea, and ophthalmoplegia were the most frequent symptoms
observed. One patient had loss of visual acuity and another exhibited peripheral facial palsy. One patient had extensive
hemifacial cutaneous necrosis. Nasal endoscopy revealed black necrotic lesions in one case, and another patient had a
tumefaction localised in the left middle meatus. Necrotic lesions were most often found in the orbit, the maxillary and
the ethmoidal sinuses on computed tomography (four cases for each site). One patient had thrombophlebitis of the
cavernous sinus, and another had an intracranial extension. All patients were administered ordinary insulin and
intravenous amphotericin B. Surgical debridement of the nasal cavity and the involved sinuses was performed through
lateral rhinotomy (four cases) or endoscopy (one case). Unilateral orbital exenteration was associated in two cases.
Progression was favourable in four cases; one patient died from sepsis despite aggressive treatment.
Conclusion: Early diagnosis is crucial for the management of RCM. Treatment of underlying disorders, use of
intravenous amphotericin B, and aggressive surgical intervention are key in reducing morbidity and mortality rates.
- Vol. 7, 2011, 3rd trimester
Rhinocerebral mucormycosis: five cases and a literature review