Rhinocerebral mucormycosis: five cases and a literature review.
OBJECTIVE
In this retrospective study, we describe our experience in the diagnosis and management of rhinocerebral mucormycosis (RCM), a rapidly lethal fungal infection.


METHODS
Between 1997 and 2007, five patients hospitalized for suspicion of RCM. Computed tomography was performed in all cases, and diagnosis was confirmed after anatomopathological or mycological examination. All patients underwent medical and surgical treatment. Follow-up was clinical and radiological with a mean period of 17 months.


RESULTS
All patients were diabetic. Exophthalmia, rhinorrhea, and ophthalmoplegia were the most frequent symptoms observed. One patient had loss of visual acuity and another exhibited peripheral facial palsy. One patient had extensive hemifacial cutaneous necrosis. Nasal endoscopy revealed black necrotic lesions in one case, and another patient had a tumefaction localised in the left middle meatus. Necrotic lesions were most often found in the orbit, the maxillary and the ethmoidal sinuses on computed tomography (four cases for each site). One patient had thrombophlebitis of the cavernous sinus, and another had an intracranial extension. All patients were administered ordinary insulin and intravenous amphotericin B. Surgical debridement of the nasal cavity and the involved sinuses was performed through lateral rhinotomy (four cases) or endoscopy (one case). Unilateral orbital exenteration was associated in two cases. Progression was favourable in four cases; one patient died from sepsis despite aggressive treatment.


CONCLUSIONS
Early diagnosis is crucial for the management of RCM. Treatment of underlying disorders, use of intravenous amphotericin B, and aggressive surgical intervention are key in reducing morbidity and mortality rates.
Department of Otorhinolaryngology-Head and Neck Surgery, Habib Thameur Hospital, Tunis, Tunisia.
C
C
Mbarek
S
S
Zribi
K
K
Khamassi
I
I
Hariga
H
H
Ouni
M
M
Ben Amor
O
O
Ben Gamra
A
A
El Khedim
D000328:Adult; D000368:Aged; D000666:Amphotericin B / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D001927:Brain Diseases / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D003646:Debridement; D005158:Facial Paralysis / Q000382:microbiology; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009091:Mucormycosis / Q000175:diagnosis* / Q000188:drug therapy; D009296:Nasal Cavity / Q000382:microbiology; D009336:Necrosis; D009668:Nose Diseases / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D010254:Paranasal Sinus Diseases / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D011379:Prognosis; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D014792:Visual Acuity; D055815:Young Adult
D000935:Antifungal Agents; D000666:Amphotericin B