Combined mucormycosis and Aspergillosis of the rhinocerebral region.
BACKGROUND
Opportunistic fungal infections are rare, life-threatening conditions and are a major cause of morbidity and mortality in immunocompromised hosts. Our experience in the management of a case of combined mucormycosis and aspergillosis of the rhinocerebral region is presented.


METHODS
The infection developed a few weeks after tooth extraction, massively involving facial structures. After diagnosis, the patient underwent prolonged combined systemic antifungal treatment. Once the local and general conditions had stabilized, an extensive surgical debridement was performed, followed by reconstruction with a pedicled myocutaneous flap.


RESULTS
This approach was curative with patient survival after 16 months.


CONCLUSIONS
Early diagnosis, early anti-fungal treatment and early stabilization of the patients' general condition are fundamental for patient survival. Surgery is necessary for fungal eradication, but must be performed according to the above conditions. Pedicled muscle flaps are considered the first reconstruction choice because of their excellent blood perfusion and resistance to fungal invasion.
Alfano
Carmine
C
Department of Plastic and Reconstructive Surgery, University La Sapienza, Rome, Italy.
Chiummariello
Stefano
S
Dessy
Luca A
LA
Bistoni
Giovanni
G
Scuderi
Nicolò
N
D000666:Amphotericin B / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D001228:Aspergillosis / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D001232:Aspergillus fumigatus / Q000302:isolation & purification; D001922:Brain Abscess / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D000077336:Caspofungin; D003131:Combined Modality Therapy; D003646:Debridement; D004359:Drug Therapy, Combination; D054714:Echinocandins; D005260:Female; D006801:Humans; D055666:Lipopeptides; D008875:Middle Aged; D009090:Mucorales / Q000302:isolation & purification; D009091:Mucormycosis / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D013517:Otorhinolaryngologic Surgical Procedures; D010254:Paranasal Sinus Diseases / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D010456:Peptides, Cyclic / Q000627:therapeutic use; D011743:Pyrimidines / Q000627:therapeutic use; D019651:Plastic Surgery Procedures; D014081:Tooth Extraction / Q000009:adverse effects; D016896:Treatment Outcome; D014230:Triazoles / Q000627:therapeutic use; D065819:Voriconazole
D000935:Antifungal Agents; D054714:Echinocandins; D055666:Lipopeptides; D010456:Peptides, Cyclic; D011743:Pyrimidines; D014230:Triazoles; D000666:Amphotericin B; D000077336:Caspofungin; D065819:Voriconazole