Fatal rhinocerebral mucormycosis in diabetic patients: report of two cases

Abstract

Mucormycosis is a potentially serious and quite rare fungal infection, caused by the Saprophytic fungus, of the order Mucorales, Absidia, Mucor, Rhizomucor and Rhizopus. These agents are commonly isolated from decomposing soil and plant material and remain dormant in healthy individuals in the respiratory and digestive tubes when inhaling or ingesting contaminated food. It becomes pathogenic when the individual gets immunocompromised and debilitated, progressing to an aggressive and often lethal clinical picture, which requires accurate diagnosis and prompt treatment. There are reports in the literature of its gastrointestinal, pulmonary, cutaneous, rhino-orbital-cerebral, endocardial and osteoarticular forms. Regardless of its location, treatment necessarily includes early clinical diagnosis, stabilization of systemic comorbidities and aggressive drug and surgical therapy, resulting in a mortality rate of up to 40% of cases. It is a relevant topic in tertiary care hospitals in terms of contamination, being a matter of concern if present in premature newborns and burn therapy units. The purpose of this article is to report a case of rhino-orbital-cerebral Mucormycosis acquired in the community by a decompensated diabetic patient who evolved with invasion of the hard palate, paranasal sinuses, orbits and cavernous sinus, spreading to the central nervous system and leading to thrombosis the cavernous sinus.