Rhinocerebral Mucormycosis: consideration of prognostic factors and treatment modality.
OBJECTIVE
Rhinocerebral mucormycosis is rare, rapidly progressive, potentially life-threatening disease, and it usually occurs in immunocompromised patients. We present our clinical experience with 12 cases and we attempt to identify the prognostic features and proper treatment protocols.


METHODS
All the cases of mucormycosis were proven by histology or culture. The prognosis was analyzed according to the predisposing factors, including underlying disease, extent of disease and surgical intervention.


RESULTS
The overall mortality rate in our series was 33.3%. 7 of the 10 operated patients recovered, while 1 of the 2 non-operated patients expired. The associated conditions included diabetes mellitus (n=9) and hematological disease (n=3). A poor prognosis was primarily related with uncontrolled underlying disease. Other associated prognostic factors were the extent of disease including orbital or intracranial extension. Surgical debridement is essential for a good prognosis, but timely intervention and complete aggressive debridement are not always needed in all patients. The patient who had slowly progressive disease also survived after conventional medical management and limited surgical debridement, including orbital preservation.


CONCLUSIONS
Control of the underlying predisposing illness along with prompt parenteral administration of amphotericin B and aggressive surgical debridement remain the essential treatments even today. Contrary to this, as described in this study, for the patients with slowly progressive disease, the aggressive surgical debridement is spared, and a successful result may be obtained with the conventional management, including medical treatment and timely limited surgical intervention.
Jung
Sang-Hee
SH
Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Kim
Sung Won
SW
Park
Chan Soon
CS
Song
Chang Eun
CE
Cho
Jin Hee
JH
Lee
Joo Hyung
JH
Kim
Nam Sik
NS
Kang
Jun Myung
JM
D000328:Adult; D000368:Aged; D000666:Amphotericin B / Q000627:therapeutic use*; D000935:Antifungal Agents / Q000627:therapeutic use*; D001927:Brain Diseases / Q000188:drug therapy / Q000382:microbiology / Q000601:surgery; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009091:Mucormycosis / Q000150:complications / Q000188:drug therapy / Q000601:surgery; D009916:Orbital Diseases / Q000382:microbiology / Q000401:mortality; D011379:Prognosis; D012220:Rhinitis / Q000188:drug therapy / Q000382:microbiology / Q000601:surgery; D015996:Survival Rate
D000935:Antifungal Agents; C068538:liposomal amphotericin B; D000666:Amphotericin B