title: A case of rhinoorbital mucormycosis in a leukemic patient with a literature review from Turkey.
abstract: Mucormycosis (Zygomycosis) is a rare, invasive, opportunistic fungal infection of the paranasal sinuses, caused by a fungus of the order Mucorales. We report a case of rhinoorbital mucormycosis caused by Rhizopus oryzae in an acute lymphoblastic leukemia patient and review the 79 Mucormycosis cases reported in the last decade from Turkey. In our case, the diagnosis was made with endoscopic appearance, computerized tomography of the paranasal sinuses, and culture of the surgical materials. Following aggressive surgical debridement and parenteral amphotericin B therapy, the patient recovered completely. In Turkish literature, rhinocerebral manifestations were the most common form of the mucormycosis (64 cases), followed by pulmonary form (6 cases). The most common risk factor was hematologic malignancies (32 cases) and diabetes mellitus (32 cases), similar to those reported from the rest of the world. The etiologic agents responsible for the review cases were Rhizopus sp., Mucor spp., Rhizomucor spp., Rhizopus oryzae, Mucor circinelloides, and Lichtheimia corymbifera. Although various treatment modalities were used, amphotericin B was the mainstay of therapy. Mortality rate was found to be 49.4% in review cases. It seems that strong clinical suspicion and early diagnosis, along with aggressive antifungal therapy and endoscopic sinus surgery, have great importance for better prognosis in mucormycosis.
authors.affiliation: Department of Microbiology, Gulhane Military Medical Academy, Ankara, Turkey, rgumral@gmail.com.
authors.forename: Ramazan
authors.initials: R
authors.lastname: Gumral
authors.forename: Uzeyir
authors.initials: U
authors.lastname: Yildizoglu
authors.forename: Mehmet Ali
authors.initials: MA
authors.lastname: Saracli
authors.forename: Kursat
authors.initials: K
authors.lastname: Kaptan
authors.forename: Fuat
authors.initials: F
authors.lastname: Tosun
authors.forename: Sinasi Taner
authors.initials: ST
authors.lastname: Yildiran
mesh_terms: D000328:Adult; D000666:Amphotericin B / Q000008:administration & dosage / Q000627:therapeutic use; D000935:Antifungal Agents / Q000008:administration & dosage / Q000627:therapeutic use; D001483:Base Sequence; D004271:DNA, Fungal / Q000235:genetics; D006801:Humans; D008297:Male; D009091:Mucormycosis / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000473:pathology; D010254:Paranasal Sinus Diseases / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000473:pathology; D010256:Paranasal Sinuses / Q000382:microbiology / Q000473:pathology; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications*; D012340:RNA, Ribosomal, 5.8S; D012233:Rhizopus / Q000187:drug effects / Q000235:genetics / Q000302:isolation & purification / Q000472:pathogenicity; D017422:Sequence Analysis, DNA; D014421:Turkey
chemical_list: D000935:Antifungal Agents; D004271:DNA, Fungal; D012340:RNA, Ribosomal, 5.8S; C068538:liposomal amphotericin B; D000666:Amphotericin B