title: Rhino-orbito-cerebral mucormycosis: five cases.
abstract: OBJECTIVE
  Mucormycosis is an invasive fungal infection usually observed in immunocompromised patients. Mucormycosis is rapidly fatal without an early diagnosis and treatment. We report five patients of rhino-orbital-cerebral mucormycosis and a literature review.
  
  
  METHODS
  The medical records of five patients presenting with rhino-orbital-cerebral mucormycosis, admitted between January 1995 and December 2007, were analyzed. All patients underwent tissue biopsy. The histologic sections revealed the presence of non-septate hyphae of the order Mucorales.
  
  
  RESULTS
  The five patients, three men and two women, between 27 and 61 years of age, were all diabetic. The main symptoms were exophthalmia (five patients), facial swelling (four patients), periorbital cellulitis (four patients), and cranial nerve palsy (four patients). Anterior rhinoscopy revealed palatine or nasal necrotic lesions in four patients. All presented with diabetic ketoacidosis and CT scan revealed rhino-orbital-cerebral involvement in every patient. All patients were given intravenous amphotericin B. Four patients underwent surgical debridement of necrotic tissue. Two patients survived.
  
  
  CONCLUSIONS
  Mucormycosis is usually a fatal infection in diabetic patients. Early diagnosis should be based on imaging data and histology. Amphotericin B must be rapidly initiated and associated with aggressive surgical debridement to reduce mortality.
authors.affiliation: Service des Maladies Infectieuses, Hôpital Universitaire Fattouma Bourguiba, 5019 Monastir, Tunisia. adnene_toumi@yahoo.fr
authors.forename: A
authors.initials: A
authors.lastname: Toumi
authors.forename: F
authors.initials: F
authors.lastname: Larbi Ammari
authors.forename: C
authors.initials: C
authors.lastname: Loussaief
authors.forename: R
authors.initials: R
authors.lastname: Hadhri
authors.forename: H
authors.initials: H
authors.lastname: Ben Brahim
authors.forename: K
authors.initials: K
authors.lastname: Harrathi
authors.forename: F
authors.initials: F
authors.lastname: Ben Romdhane
authors.forename: J
authors.initials: J
authors.lastname: Koubaa
authors.forename: M
authors.initials: M
authors.lastname: Chakroun
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced; D000328:Adult; D000368:Aged; D000666:Amphotericin B / Q000009:adverse effects / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D001706:Biopsy; D020226:Cavernous Sinus Thrombosis / Q000209:etiology; D003131:Combined Modality Therapy; D003389:Cranial Nerve Diseases / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000382:microbiology / Q000601:surgery; D003646:Debridement; D048909:Diabetes Complications / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000382:microbiology / Q000601:surgery; D016883:Diabetic Ketoacidosis / Q000150:complications; D004198:Disease Susceptibility; D057915:Drug Substitution; D004660:Encephalitis / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000382:microbiology*; D005094:Exophthalmos / Q000209:etiology; D005260:Female; D006801:Humans; D007654:Ketoconazole / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009090:Mucorales / Q000302:isolation & purification; D009091:Mucormycosis / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality / Q000601:surgery; D054517:Orbital Cellulitis / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000382:microbiology* / Q000601:surgery; D012189:Retrospective Studies; D012220:Rhinitis / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000382:microbiology* / Q000601:surgery; D012852:Sinusitis / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000382:microbiology*; D014057:Tomography, X-Ray Computed
chemical_list: D000935:Antifungal Agents; D000666:Amphotericin B; D007654:Ketoconazole