Chronic rhinocerebral mucormycosis: a rare case report and review of the literature

Abstract

Rhinocerebral mucormycosis is an invasive infection caused by filamentous fungi of the Mucoraceae family. The rhinocerebral form of the disease represents the most common form and has two distinct clinical entities. The common presentation consists of a rapidly progressive infection with high mortality rate, while the other presentation is that of a chronic infection with lower mortality. In the present paper we report a rare case of chronic rhinocerebral mucormycosis. An 85-year-old male with a 6-month history of purulent and odorous nasal discharge, and sporadic episodes of epistaxis and anosmia, presented to the outpatient department of our clinic. Initial cultures were positive only for Pseudomonas aeruginosa. The patient was unresponsive to ciprofloxacin treatment, developing necrotic areas of the nasal septum suspicious for rhinocerebral mucormycosis. Admission to the ENT clinic followed, with histopathologic evaluation of the vomer bone confirming the diagnosis. The patient was treated with amphotericin B and was discharged 3 weeks later on oral posaconazole therapy. Chronic rhinocerebral mucormycosis may present with atypical symptoms or coinfection with another agent. A high degree of clinical suspicion is required for correct diagnosis and prompt initiation of appropriate treatment.

Fungal Infections Complicating Lung Transplantation

“…Risk factors for mucormycosis include poorly controlled diabetes; 39,112,[120][121][122][123][124] hematological malignancies with neutropenia; 123,[125][126][127][128][129][130] HSCT; 14,22,[32][33][34] SOT; 8,34,[38][39][40][41][42][43][44] immunosuppression; 131,132 human immunodeficiency virus (HIV) infection; 111,133-136 peritoneal dialysis; [137][138][139] iron overload states; [51][52][53] and prior receipt of VCZ. 33,123,[140][141][142] Mucormycosis rarely affects immunocompetent persons, but cutaneous, rhino-orbital, and (rarely) disseminated infections may occur following local cutaneous or soft tissue trauma.…”

Invasive Rhinosinusitis due to Alternaria alternata and Rhizopus arrhizus Mixed Infection: A Case Report and Review

“…There are also few reports of allergic fungal sinusitis (13,14). Further bacterial coinfection with Psuedomonas has been reported in chronic invasive rhinocerebral mucormycosis (3). Fungal coinfection has also been reported.…”

Rhinocerebral mucormycosis: report of a rare case

“…Rhizopus species are the most common causative organisms (1,2). Saprophytic aerobic fungi of the class Phycomycetes (order Mucorales) cause rhinocerebral mucormycosis, also known as phycomycosis.…”