[Invasive sinusitis after allogenic stem cell transplantation - Case 4/2010].
METHODS
More than two years after unrelated stem cell transplantation with ongoing immunosuppressive therapy due to chronic graft-versus-host disease a patient was admitted with dyspnea. In the sequel, the patient developed ptosis.


METHODS
CT scan of paranasal sinus demonstrated an orbita-infiltrating tumor identified as mucormycosis by microbiology and biopsy. Further diagnostics showed cerebral involvement. Due to additional pancytopenia a conservative approach to this rhino-orbito-cerebral mucormycosis was chosen.


METHODS
With dose intensive liposomal amphotericin B and posaconazol maintenance therapy stabilization followed by continuously regression was achieved.


CONCLUSIONS
Infections with mucorales have a low incidence, though due to rapid progression and high mortality they should be included into diagnostic considerations. Diagnosis is confirmed by biopsy and therapy is primarily operative. Systemic therapy is targeted to eliminate underlying risk factors (cytopenia, immunosuppression, ketoacidosis, iron overload) and application of effective antimycotics as mono- or combined therapy.
Wirths
Stefan
S
Abteilung für Hämatologie, Onkologie, Immunologie, Rheumatologie und Pulmologie, Medizinische Universitätsklink Tübingen, Tübingen. stefan.wirths@med.uni-tuebingen.de
Schaub
Valdete
V
Adam
Patrick
P
Horger
Marius
M
Faul
Christoph
C
D002177:Candidiasis / Q000175:diagnosis* / Q000209:etiology*; D003937:Diagnosis, Differential; D006801:Humans; D008297:Male; D008875:Middle Aged; D012852:Sinusitis / Q000175:diagnosis* / Q000209:etiology*; D033581:Stem Cell Transplantation / Q000009:adverse effects*