Rhino-orbito-cerebral mucormycosis: report of two cases and review of the literature

Abstract

Rhino-orbito-cerebral mucormycosis (ROCM) is a rare, fulminant opportunistic fungal infection that is mostly seen in immunocompromised or diabetic patients. The disease should be recognised and treated immediately. We present here MR imaging findings of two patients with histopathologically proven ROCM. One of the cases had a history of corticosteroid treatment and iatrogenic diabetes mellitus and although amphotericin B was started immediately, the disease progressed and surgical debridement was necessary. The second case was a patient with diabetes mellitus type 1 in whom ROCM had occurred following an abdominal surgery; amphotericin B treatment alone was adequate in this patient.

Neuronavigation-Guided Endoscopic Endonasal Resection of Extensive Skull Base Mucormycosis Complicated With Cerebral Vasospasm

“…22 The common presenting symptoms and signs are headache, fever, acute sinusitis, decreased vision, unilateral periorbital or facial swelling, facial pain, alterations in mental state, and necrotic ulcer in the nasal or the oral mucosa. 23 Although rare, orbital apex syndrome, which presents with ptosis, proptosis, sensorial deficit, and visual loss, may be the initial manifestation of the disease. 24 In our case, our patient's first presentation was left eye ptosis and bilateral abducens nerve palsy, correlating with invasiveness of the disease.…”

Rhino-orbital mucourmycosis in a non-immunocompromised patient

“…The most common form of presentation is pulmonary mucormycosis, which accounts for 64% and involves orbital and maxillofacial areas in 24%. For decades, the death rate of mucormycosis has remained high, despite aggressive surgical and polyene antifungal therapy 5 9 10…”

“…The common presenting symptoms and signs are headache, fever, acute sinusitis, decreased vision, unilateral periorbital or facial swelling, facial pain, alterations in mental state and necrotic ulcer in the nasal or oral mucosa. Although rare, the orbital apex syndrome which presents with ptosis, proptosis, ophthalmoplegia, sensory deficit and visual loss may be the initial manifestation of the disease 4 5 11. The rhinocerebral type is usually subdivided into types 1 and 2.…”

A report of successfully treated rhino-orbital mucormycosis

“…3 Opportunistic fungal infections are usually associated with diabetic ketoacidosis, lymphoma, leukaemia, corticosteroid treatment, radiation therapy, chemotherapy, myelodysplastic syndrome, aplastic anaemia and acquired immunodeficiency syndrome. 4 …”