Rare case of a chronic rhinocerebral mucormycosis.

We describe a case of rhino-orbital-cerebral mucormycosis (ROCM) in a diabetic patient. She presented with cavernous sinus syndrome and ischemia of the optic nerve. Initially unremarkable findings in the nasal cavity and paranasal sinus delayed early diagnosis. Within two weeks, a follow-up MRI showing progressive orbital inflammation, thrombosis of the cavernous sinus and erosive destruction of the left middle nasal concha together with necrotic black tissue in the left nasal cavity and destruction of the maxillary sinus demonstrated in a consecutively performed ethmoidectomy, finally gave way to diagnosis. Definite diagnosis was established by histopathology and culture. Treatment consisted of a combination of liposomal Amphotericin B, partial surgical resection and improved diabetes control. Despite insufficient surgical treatment, the progression of the disease was remarkably slow - a typical hallmark of chronic ROCM. With this case report we aim to underline the difficulties in establishing a prompt diagnosis of ROCM and to remind readers of its chronic form. 2012 Elsevier Ltd. All rights reserved.

[An Unusual Cause for a Bilateral Ptosis]. / Ungewöhnliche Ursache einer bilateralen Ptose.

An Unusual Cause for a Bilateral Ptosis Abstract. Immune-checkpoint-inhibitors are increasingly used in various malignancies. Autoimmune side effects such as colitis, hepatitis or skin reactions are well known, on the other hand neurological autoimmune complications such as myasthenic syndromes, myopathies or overlap syndromes with potentially life-threatening complications are less common and not well understood. A precise diagnosis has far reaching therapeutic consequences. Here we present the case of a patient under immune checkpoint inhibitor therapy, in which the diagnosis, due to the presence of overlap symptoms, is shown to be challenging. However, it was crucial to find the correct diagnosis in order to choose the proper therapy.

Oligodendrocytes Provide Antioxidant Defense Function for Neurons by Secreting Ferritin Heavy Chain.

An evolutionarily conserved function of glia is to provide metabolic and structural support for neurons. To identify molecules generated by glia and with vital functions for neurons, we used Drosophila melanogaster as a screening tool, and subsequently translated the findings to mice. We found that a cargo receptor operating in the secretory pathway of glia was essential to maintain axonal integrity by regulating iron buffering. Ferritin heavy chain was identified as the critical secretory cargo, required for the protection against iron-mediated ferroptotic axonal damage. In mice, ferritin heavy chain is highly expressed by oligodendrocytes and secreted by employing an unconventional secretion pathway involving extracellular vesicles. Disrupting the release of extracellular vesicles or the expression of ferritin heavy chain in oligodendrocytes causes neuronal loss and oxidative damage in mice. Our data point to a role of oligodendrocytes in providing an antioxidant defense system to support neurons against iron-mediated cytotoxicity.