title: Fatal rhinocerebral mucormycosis with intracavernous carotid aneurysm and thrombosis: a late complication of transsphenoidal surgery?
abstract: Mucormycosis is a rare opportunistic fungal infection. Rhinocerebral form of the disease mainly affects diabetic or immunocompromised patients. Mucormycosis have specific tropism for blood vessels leading to mucorthrombosis and less often to mycotic aneurysms. We report on a patient initially presenting with a severe sphenoid sinusopathy, who progressively evolved to cavernous sinus syndrome, internal carotid aneurysm followed by spontaneous thrombosis, chronic meningitis and ultimately fatal hypertensive hydrocephalus. Necropsy revealed a purulent infiltrate containing thin-walled, aseptate, right-angle branching, hyphae consistent with mucormycosis. His only relevant previous medical history was a transsphenoidal surgery for pituitary macroadenoma 21 years before. We hypothesize that post-surgical mucosal changes in the sphenoid sinus have been a favoring factor for delayed and invasive mucor infection.
authors.affiliation: Service de Neurologie, Cliniques universitaires Saint-Luc, Université Catholique de Louvain, Avenue Hippocrate 10, Brussels, Belgium. dusart.a@gmail.com
authors.forename: Anne
authors.initials: A
authors.lastname: Dusart
authors.forename: Thierry
authors.initials: T
authors.lastname: Duprez
authors.forename: Sylvie
authors.initials: S
authors.lastname: Van Snick
authors.forename: Catherine
authors.initials: C
authors.lastname: Godfraind
authors.forename: Christian
authors.initials: C
authors.lastname: Sindic
mesh_terms: D000783:Aneurysm / Q000209:etiology* / Q000473:pathology; D002340:Carotid Artery Diseases / Q000209:etiology* / Q000473:pathology; D002426:Cavernous Sinus / Q000382:microbiology / Q000473:pathology; D020226:Cavernous Sinus Thrombosis / Q000209:etiology* / Q000473:pathology; D017809:Fatal Outcome; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009091:Mucormycosis / Q000209:etiology* / Q000473:pathology; D011183:Postoperative Complications / Q000209:etiology* / Q000473:pathology; D013100:Sphenoid Bone / Q000473:pathology