Successful treatment of rhinocerebral mucormycosis by a combination of aggressive surgical debridement and the use of systemic liposomal amphotericin B and local therapy with nebulized amphotericin – a case report

Abstract

A case of mucormycosis involving the nose and paranasalsinuses in a 55-year-old man with recently diagnosed acute promyelocytic leukaemia is reported. It was successfully treated with a combination of aggressive surgical debridement and systemic amphotericin B. In addition, local nebulized amphotericin B was used as an adjunct totherapy. We believe this is only the second documented use of nebulized amphotericin in the management of sinonasal mucormycosis. The needfor a high index of suspicion and early aggressive management is emphasized.

Current Perspectives on Ophthalmic Mycoses

“…Other putative risk factors for rhinocerebral zygomycosis include protein-calorie malnutrition and iron overload (with or (74,265,308,323). When disease occurs in nonimmunocompromised individuals, which is rare, there is usually some associated antibiotic use or a breakdown in the mucocutaneous barrier (32,292,340); such patients may fare better than immunocompromised patients.…”

“…These formulations have been used in small numbers of patients with rhinocerebral zygomycosis (257,308,340,368), with favorable outcomes being reported (Table 13). These preliminary results require corroboration in controlled clinical trials on larger numbers of patients.…”

Isolated palate ulcer due to mucormycosis

“…Vascular occlusion results in ischemia and infarction. Infarction produces the characteristic black necrotic eschars on the nasal or palatine mucosa [2] in these patients. Direct penetration and growth through the blood vessels wall explain the propensity for thrombosis and tissue necrosis, two major hallmarks of the histopatholgy of mucormycosis [3].…”

“…The increased oxygen tension allows the fi broblasts to lay down new collagen providing a framework for new vessel formation and facilitates wound healing. With earlier diagnosis and a combination of amphotericin-B and radical debridement of infected tissues, the fatality rate has dropped [2,5] .The prognosis of the disease surely depends on how early and aggressively it is managed. Overall the earlier the diagnosis of mucormycosis is made, the better is the outcome.…”

“…More over, trauma of the hard palate is rare. Mucormycosis is a generic term that includes fungal infections caused by the genera Mucor, Rhizopus, Absidia and others [2]. This fungus is ordinarily saprophytic, but can become an aggressive pathogen under the appropriate conditions, usually a serious predisposition in the host.…”