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[Rhinocerebral mucormycosis].

Mucormycosis is unusual in ORL pathology. We present a case of a 53-year-old patient in the dialysis program for the past 6 years for renal insufficiency. Starting with some trouble in the left lacrimal region, he was diagnosed by his ophthalmologist as having deep dacryocystitis, appearing as an ulcero-necrotic lesion on the same side of the nasal dorsum. In the presumption of clinical mucormycosis, a microbiological and histological study was done to confirm the diagnosis, starting treatment with amphotericin B. Because of the rapid extension of the lesion, surgical debridement of the zone was done but his evolution was bad, lapsing into a coma and requiring a neurosurgical operation for intracranial complications. The patient died 12 days after admission. For that reason we did an evaluation of the problem and also a review of the literature.

Amphotericin B↗
PubMed1989

Mucormycosis of the head and neck.

Rhinocerebral mucormycosis is an uncommon but devastating infection of the head and neck. The fungus most commonly affects diabetics who are in ketoacidosis, but can affect other immunosuppressed individuals such as leukemics, burn patients, and patients with chronic renal failure. The pathogenicity of the organism is characterized by a ketone reductase system and its ability to invade arterial blood vessels. Treatment is directed towards correction of the underlying disorder, surgical debridement, intravenous antifungal agents, and possibly a new adjuvant, hyperbaric oxygen. A detailed review of this disease process is provided, along with the recent advances and successes in treating rhinocerebral mucormycosis.

Brain Diseases↗
PubMed1989

[A case of disseminated mucormycosis].

Report of a case of disseminated mucormycosis. The Authors, after a review of the literature, report a fatal case of disseminated Mucormycosis observed in a young patient with aplastic anemia, severe neutropenia and treated with Deferoxamine.

Adult↗
PubMed1989

[Mucormycosis of the face associated with aspergillosis in the diabetic patient. Diagnostic and therapeutic considerations].

Facial mucormycosis is a rare fungal infection which spreads rapidly and has a severe prognosis. It mainly affects insulin-dependent diabetics and immunodeficient subjects. We report about a case of mucormycosis of the facial structures in a diabetic patient, and lay particular stress on the diagnosis difficulties, on treatment and on evolution, which led to healing, leaving an extensive bony sequestrum which preserved the contents of the orbits.

Amphotericin B↗
PubMed1977

[Cranial mucormycosis in a patient with a transplanted kidney].

Mucormycosis is a very serious complication of debilitating diseases, and particularly of diabetes. Presently the treatment of choice is amphotericine B. A patient is described who, like most other renal transplant patients with mucormycosis, had cranial localization of this disease and diabetes. The clinical findings were classical and the diagnosis was confirmed histologically.

Adult↗
PubMed1986

[Rhinocerebral mucormycosis as a complication of cytostatic therapy].

A twelve year old boy with acute lymphoblastic leukemia was treated with combination chemotherapy. Two weeks later a cellulitis of the left upper and lower eyelid appeared, followed by a rapidly increasing, deep necrotic inflammation of the periorbital area leading to proptosis. Mucormycosis was identified by histology and microbiology. The spreading inflammatory process was arrested by amphotericin B in a total dose of 1.2 g combined with a drainage of the necrotic tissue of the paranasal sinus, left orbit and bifrontal cerebral abscess. The patient is still in complete continuous remission four years later but a large defect of the nasal, maxillary and orbital area remains. This case demonstrates that the usual fatal outcome of mucormycosis in leukemia is curable with amphotericin B and aggressive surgery.

Amphotericin B↗
PubMed1985

Mucormycosis in renal transplant patients--a report of two cases and review of the literature.

Mucormycosis is a rare complication of diabetic ketoacidosis and immunosuppressed states, such as those occurring after renal transplantation. We describe two cases of mucormycosis in renal allograft recipients and present a review of similar cases previously reported. An analysis of these data suggests that renal transplant patients with concomitant diabetes mellitus are most susceptible to developing this complication.

Brain↗
PubMed1977

Pulmonary and rhinocerebral mucormycosis. Successful outcome with amphotericin B and griseofulvin therapy.

An ominous prognosis is associated with combined pulmonary and rhinocerebral mucormycosis (phycomycosis). We report the case of a diabetic patient with ketoacidosis who had extensive pulmonary and rhinocerebral mucormycosis that responded satisfactorily to amphotericin B and griseofulvin therapy. The affected lung is completely atelectatic and has remained so for 12 months without evidence of necrosis or abscess formation.

Adult↗
PubMed1985

[Pulmonary mucormycosis. A case of successful treatment and a review of the literature].

A patient with documented mucormycosis survived after nephrectomy, lobectomy and Amphotericin B therapy. This is only the twentieth successfully treated patient with pulmonary mucormycosis reported in the English literature. A review of the literature reveals that aggressive surgical debridement remains the sine qua non for a successful outcome. However, Amphotericin B provides a necessary adjunct to the treatment of this systemic disease.

Adult↗
PubMed1979

[Cranial mucormycosis with thrombosis of the sinus cavernosus (author's transl)].

A case of mucormycosis in a 45 year-old woman with uncontrolled diabetes is reported. Following dental extractions, the patient presented with total ophthalmoplegia, chemosis and complete sensory loss of the right fifth cranial nerve. Exophthalmus was not present. Although a fungal infection was suspected, administration of Amphotericin B was avoided because of renal insufficiency. After temporary clinical improvement with high doses of antibiotics, signs of right seventh and eighth cranial nerve paralysis and of thrombosis of the right ophthalmic artery developed. The patient expired after six days. Autopsy disclosed extensive mucormycosis with involvement of the nasal cavity and paranasal sinuses, soft tissues and bones of face and orbit, cranial nerves, meninges and base of the brain, as well as mycotic thrombosis of the right cavernous sinus and the internal carotid, ophthalmic and maxillary arteries. The spread of infection is detailed, and the importance of an early diagnosis is stressed.

Carotid Artery Diseases↗
PubMed1983

Successful therapy for rhinocerebral mucormycosis with associated bilateral brain abscesses.

A case of extensive rhinocerebral mucormycosis, with associated bilateral brain abscesses, occurred in a man with diabetes. A Rhizopus sp grew from the initial nasal biopsy specimens. Successful therapy consisted of correcting metabolic acidosis, using serial computed tomographic (CT) scans to follow the progressive course of brain involvement from cerebritis to encapsulated abscesses, and performing successive biopsies to determine the adequacy of treatment. On 18-month follow-up, the patient had returned to full-time employment with minimal neurologic impairment. With CT scanning and aggressive therapy, rhinocerebral mucormycosis with bilateral brain involvement can be cured.

Adult↗
PubMed1982

Mucormycosis and cutaneous histoplasmosis in a renal transplant recipient.

Mucormycosis of the palate developed in a 31-year-old man while he was undergoing immunosuppression with prednisone and azathioprine after renal transplantation. The infection was excised and did not recur. Ten years later, while still receiving immunosuppressive therapy, cutaneous histoplasmosis of the fingers developed, which was treated successfully with intravenous amphotericin B. The occurrence of mucormycosis and histoplasmosis in this man emphasizes the need to suspect uncommon infections when unusual skin lesions occur in an immunosuppressed patient.

Adult↗
PubMed1982

Rhinocerebral mucormycosis: predisposing factors.

Rhinocerebral mucormycosis is, with few exceptions, only reported in patients with severe metabolic or immunologic imbalances. Factors which may predispose to the development of mucormycosis are reviewed. These factors include ketoacidosis and immunologic deficiency states due either to the primary disease or to the treatment for other diseases. An appreciation for these predisposing factors is very important in order that aggressive diagnosis and therapy be undertaken without delay.

Acidosis↗
PubMed1994

[Pulmonary mucormycosis in leukemic patients. Apropos of 2 cases].

Mucormycosis is a rare fungal infection that has been described mainly in oncologic and diabetic patients. We here report the cases of two leukaemic patients in whom pulmonary mucormycosis was diagnosed. Prompt diagnosis, therapy with amphotericin B and surgery when possible, are the cornerstones in the treatment of this fungal infection. Although infrequent, this infection must be suspected in oncohaematological patients with lung infiltrates.

Adult↗
PubMed1994

Rhinocerebral mucormycosis presenting as periorbital cellulitis with blindness: report of 2 cases.

Two cases of rhinocerebral mucormycosis in elderly, non-ketotic diabetics who were initially diagnosed and treated for bacterial periorbital cellulitis are reported. Both presented with a short history of periorbital pain and swelling followed rapidly by complete ophthalmoplegia and blindness. By the time of correct diagnosis, both cases were advanced with lower cranial nerve involvement, CT evidence of ophthalmic artery and cavernous sinus thrombosis and, in one, internal carotid artery invasion (demonstrated on MR angiography) with resultant cerebral infarction. One patient was treated with intravenous amphotericin B but died within a few days. The second patient had aggressive surgical resection and survived with significant residual morbidity. These cases illustrate that mucormycosis should be excluded in any diabetic patient presenting with orbital cellulitis, especially when there is early visual loss. Early aggressive treatment with surgery and antifungal agents is often successful whereas the outcome is almost universally fatal when the diagnosis is delayed.

Aged↗
PubMed1994

Primary cutaneous mucormycosis with a Mucor species: is iron overload a factor?

A severely debilitated patient showed primary cutaneous mucormycosis with a Mucor species at a tape erosion site. The pathogenic nature and epidemiologic features of this unusual fungal infection are reviewed to emphasize its recognition in the differential diagnosis of ischemic lesions in immunocompromised patients. Iron overload may be a risk factor for mucormycosis.

Dermatomycoses↗
PubMed1994

[Rhinocerebral mucormycosis in type 2 diabetes mellitus. Description of a clinical case with favorable outcome].

The case is reported of a 70-year-old man with decompensated non-acidotic type-2 diabetes mellitus and with rhinocerebral mucormycosis, manifested by inflammatory infiltration of the left nasal, paranasal, maxillary, and orbital bone structures with left ophthalmoplegia. The patient was cured after amphotericin B treatment (total dose 2.7 g) and 30 sessions of hyperbaric oxygen (2.8 atmospheres). Cure was confirmed by follow-up over more than 2 years. It is concluded that rhinocerebral mucormycosis must be treated, in addition to control of predisposing factors, and especially by restoring endocrine-metabolic balance, by adequate surgical revision, with specific high-dose amphotericin B treatment and adjunctive hyperbaric oxygen. Further studies are desirable in order to define the advantages of these therapeutic measures.

Aged↗