Report of four cases of rhinocerebral mucormycosis in Loghman hospital in 1388

ABSTRACT

Rhinocerebral mucormycosis is an aggressive fungal disease that involves the nose, paranasal sinuses, orbit and central nervous system. It may rapidly be fatal. This infection usually occurs secondary to immune suppression, diabetic ketoacidosis, and prolonged use of antibiotics, steroids, and cytotoxic drugs. Management of the condition consists of treatment of the underlying disease and surgical debridement combined with intravenous amphotericin-B. We presented 4 cases of rhinocerebral mucormycosis with same presentation. They presented with coryza, erythema and swelling of periorbital area several days before admission. Symptoms progressed quickly and ptosis and chemosis developed. Paranasal CT scan showed opacification in ethmoid, frontal and maxillary sinuses. Diagnostic endoscope showed necrosis in orbit and nasal root. Orbital exenteration, necrotic tissue debridment was done. Smear of necrotic tissue showed branching nonseptated mycelium in favor of mucoral. Culture of necrotis tissue showed rhizopus. Amphotericin-B started for all the patients. Two patients expired in spit of extensive surgical debridment and medical therapy and two survived. The diagnosis of rhinocerebral mucormycosis should be considered in the clinical setting of necrotic sinusitis and acute neurologic deficit in diabetic patients. Early diagnosis and treatment are crucial factors leading to a good outcome: