A case of rhinocerebral mucormycosis with brain abscess drained by endoscopic endonasal skull base surgery

Abstract

A 70-year-old Japanese man undergoing remission induction therapy for acute monocytic leukemia (AML-M5b) developed fever and headache, and was started on antibiotics and liposomal amphotericin B (L-AMB). There was no improvement, and computed tomography and contrast-enhanced magnetic resonance imaging revealed acute rhinosinusitis and brain abscess. Successful endoscopic endonasal surgery was performed at this point, providing drainage for the rhinosinusitis and abscess. Histopathological findings showed the mucormycosis.

Rhinocerebral Mucormycosis With Brain Abscess Presenting as Status Epileptucus in a COVID-19-Infected Male: A Calamitous Complication

“…Uraguchi et al in their study had treated a case of rhinocerebral mucormycosis with brain abscess drained by endoscopic endonasal skull base surgery in a 70-year-old male [9].…”

COVID‐19‐related rhino‐orbital‐cerebral mucormycosis: Neurological manifestation and related risk factors in two cases

“…Mucormycosis infects the nervous system in 20% of hematological cases and brain abscess occurs rarely in 2 of 43 patients with mucormycosis. 5,6 Unfortunately, it has been observed that mucormycosis has been rising since the COVID-19 pandemic began, and recently it has become an issue of concern for our healthcare system. 1 The condition could be a consequence of a dysregulated immune system due to a reduction in T cell count, altered CD4/CD8 ratio, and overuse of immunosuppresses like corticosteroids following the COVID-19 which is exacerbated by uncontrolled blood sugar in people with undetermined diabetes cases.…”

“…Mucormycosis has five different spread sites: rhino‐cerebral, gastrointestinal, cutaneous, respiratory, and disseminated. ROCM is the predominant manifestation of the infection which can progress to the orbital and deeper sites of the brain through paranasal sinuses 1,5 and could result in uncommon presentations such as seizures, reduced LOC, or ophthalmic involvement. Mucormycosis infects the nervous system in 20% of hematological cases and brain abscess occurs rarely in 2 of 43 patients with mucormycosis 5,6 .…”

A Case of Rhino-Orbital Cerebral Mucormycosis presenting with spontaneous Cerebrospinal fluid Rhinorrhoea

“…Cerebrospinal uid rhinorrhea is rarely documented with such fungal infection in literature. There are only a few case reports of iatrogenic CSF rhinorrhea in ROCM during orbital exenteration and sinus surgery [8,9,10] .…”