title: Combined mucormycosis and Aspergillosis of the rhinocerebral region.
abstract: 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.
authors.affiliation: Department of Plastic and Reconstructive Surgery, University La Sapienza, Rome, Italy.
authors.forename: Carmine
authors.initials: C
authors.lastname: Alfano
authors.forename: Stefano
authors.initials: S
authors.lastname: Chiummariello
authors.forename: Luca A
authors.initials: LA
authors.lastname: Dessy
authors.forename: Giovanni
authors.initials: G
authors.lastname: Bistoni
authors.forename: Nicolò
authors.initials: N
authors.lastname: Scuderi
mesh_terms: 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
chemical_list: D000935:Antifungal Agents; D054714:Echinocandins; D055666:Lipopeptides; D010456:Peptides, Cyclic; D011743:Pyrimidines; D014230:Triazoles; D000666:Amphotericin B; D000077336:Caspofungin; D065819:Voriconazole