Atypical Presentations of Mucormycosis in the Head and Neck

Abstract

H|V|ucormycosis is a fungal infection caused by a member of the family Mucoraceae of the subclass Zygomycetes of the class Phycomycetes. Within this subclass are the genera Rhizopus, Mucor, and Absidia. Morphologically, they are nonseptate, broad hyphae (5 to 50 fxm), with branches at right angles. They may be seen histologically with hematoxylin and eosin staining, Grocott-Gomori methenaminesilver nitrate staining, and occasionally periodic acid-Schiff stainingJ -3 They invade tissue with a particular affinity for blood vessels, leading to thrombosis and tissue ischemia. 4 These fungi are ubiquitous in bread and fruit molds and may be found in soil, manure, plants, vegetable matter, and air] '5'6 There is some evidence that they are present in the gastrointestinal and respiratory tracts of healthy individuals. 1' 6 Rhizopus is responsible for 60% of all cases of mucormycosis and 90% of rhinocerebral mucormycosis. In the majority of cases of rhinocerebral mucormycosis, the organism gains access to the patient through the nose] This fungi may, however, enter through any disruption of mucosa or skin/ It is reported that there are as many as seven clinical syndromes of mucormycosis. 8 The five major forms include (1) rhinocerebral, the most common and the most fatal; (2) pulmonary; (3) gastrointestinal; (4) disseminated; and (5) cutaneous. 5 A rare form, nasopharyngeal mucormycotic osteitis, has also been reported, 9 as have a few cases of isolated central nervous system involvement. 1°-12The first case of mucormycosis was reported by Paltauf in 1885, but it was not until 1955 that Harris

Atypical Presentations of Post-Covid Mucormycosis

“…They are seen histologically with Hematoxillin and Eosin staining, Grocott-Gomori methamine staining, and occasionally Periodic acid Schiff staining. 5 They invade tissues with a particular affinity for In the 1st case we see a middle aged male presenting with Rhinocerebral and disseminated (Penile) mucormycosis, treated with FESS+Maxillectomy and partial penectomy.…”

Two Cases of Rhinocerebral Mucormycosis

“…The infected site shows typical black eschars, which may subsequently ulcerate or perforate. 11) In cases of ulcers of the palate, malignant diseases such as Wegner's granulomatosis, neurosyphilis, tuberculosis, lymphoma, squamous cell carcinoma, and minor salivary gland tumors should be excluded, which requires a biopsy. The diagnosis of mucormycosis can be made by detecting aseptate, right-angled branching hyphae through direct microscopy or histopathological examination.…”

“…However, the recent surgical trend has been towards diagnosis and necrotic debridement under endoscopy. 11) In the 1960s, when amphotericin had not yet been developed, mucormycosis was considered to be fatal. 8) Because…”

Post-Covid Orofacial Mucormycosis: A Clinico-Radiological Classification System and Management Protocol

“…Spores also may be inhaled into the lower respiratory tract which causes the pulmonary type of mucormycosis. Other presentations include the gastro-intestinal, cutaneous, bone, renal, cardiac and mediastinal mucormycosis [ 9 , 10 ].…”