Unexpected Expansive Paranasal Sinus Mucormycosis

Larsen, Kristian; Buchwald, Christian von; Ellefsen, Bjarki; Francis, Dorthe

doi:10.1159/000068657

Cited by 17 publications

(9 citation statements)

References 10 publications

(21 reference statements)

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“…Mucormycosis virtually always occurs in patients with defects in host defense and/or with increased available serum iron, although rare cases have been reported in apparently normal hosts (83,85,119). In most cases, the infection is relentlessly progressive and results in death unless treatment with a combination of surgical debridement and antifungal therapy is initiated promptly.…”

Section: General Principlesmentioning

confidence: 99%

Novel Perspectives on Mucormycosis: Pathophysiology, Presentation, and Management

2005

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Mucormycosis is a life-threatening fungal infection that occurs in immunocompromised patients. These infections are becoming increasingly common, yet survival remains very poor. A greater understanding of the pathogenesis of the disease may lead to future therapies. For example, it is now clear that iron metabolism plays a central role in regulating mucormycosis infections and that deferoxamine predisposes patients to mucormycosis by inappropriately supplying the fungus with iron. These findings raise the possibility that iron chelator therapy may be useful to treat the infection as long as the chelator does not inappropriately supply the fungus with iron. Recent data support the concept that high-dose liposomal amphotericin is the preferred monotherapy for mucormycosis. However, several novel therapeutic strategies are available. These options include combination therapy using lipid-based amphotericin with an echinocandin or with an azole (largely itraconazole or posaconazole) or with all three. The underlying principles of therapy for this disease remain rapid diagnosis, reversal of underlying predisposition, and urgent surgical debridement

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Section: General Principlesmentioning

confidence: 99%

Novel Perspectives on Mucormycosis: Pathophysiology, Presentation, and Management

2005

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“…In the clinical setting, in a retrospective study, polyene and CAS combination therapy was associated with a significantly higher success rate, compared with polyene monotherapy [8]. In our patient, combined antifungal therapy and rapid recovery from neutropenia could have helped to limit the spread of infection either locally or to other sites [5,6,14]. …”

Section: Discussionmentioning

confidence: 86%

Lessons from a Case of Oromandibular Mucormycosis Treated with Surgery and a Combination of Amphotericin B Lipid Formulation plus Caspofungin

Ojeda-Uribe

Herbrecht²,

Kiefer³

et al. 2010

Acta Haematol

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A rare case of oromandibular Rhizopus oryzae infection is described in a 55-year-old woman with acute myeloid leukaemia and decompensated diabetes mellitus. The infection developed during induction chemotherapy when the patient was neutropenic. She was treated with a combination of amphotericin B lipid formulation and caspofungin plus surgery. Debridement surgery included excision of the lower lip, chin, floor of the mouth, a portion of the tongue, as well as mandibular resection at the level of the horizontal branches. Eight weeks of combined antifungal therapy were followed by secondary prophylaxis with amphotericin B lipid formulation during consolidation chemotherapy after achieving complete response of both leukaemia and mucormycosis. Reconstructive surgery was carried out including insertion of a new biomaterial porous mandibular prosthesis, which showed excellent functionality after long-term follow-up, followed by several plastic surgery procedures once good tolerability and no adverse effects of the prosthesis were observed. This case shows that a well-coordinated multidisciplinary approach is critical to increase the chances of clinical success in this life-threatening infection.

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“…All cases of patients with no predisposing factors (diabetes mellitus; immune suppression; intravenous drug abuse; iron overload or deferoxamine treatment; s/p trauma recently in the same area of mucormycosis infection) : Cases included were those with acute mucormycosis infection in the rhinocerebral region diagnosed by histology with or without a positive culture, when no known predisposing conditions for rhinocerebral mucormycosis were reported and data regarding outcome were available. Our search yielded a total of 73 cases including the present case [2,3,6–42] (Table 1).…”

Section: Case Reportmentioning

confidence: 99%

Rhinocerebral mucormycosis in patients without predisposing medical conditions: a review of the literature

Elinav

Zimhony

Cohen

et al. 2009

Clinical Microbiology and Infection

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Rhinocerebral mucormycosis is a rare disease, affecting almost exclusively patients with known predisposing conditions such as diabetes mellitus, immunocompromised status, haemochromatosis or major trauma. Subsequent to a case of rhinocerebral mucormycosis in a 78-year-old woman without any known risk factor, we reviewed the published English-language literature and found an additional 72 cases. Reviewing all the published case series of mucormycosis involving any site, the proportion of apparently normal hosts among cases of rhinocerebral mucormycosis was found to be 9.06% (95% confidence interval 6.7-11.8). These findings suggest that rhinocerebral mucormycosis in patients without known predisposing factors is more prevalent than was previously believed.

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Unexpected Expansive Paranasal Sinus Mucormycosis

Cited by 17 publications

References 10 publications

Novel Perspectives on Mucormycosis: Pathophysiology, Presentation, and Management

Novel Perspectives on Mucormycosis: Pathophysiology, Presentation, and Management

Lessons from a Case of Oromandibular Mucormycosis Treated with Surgery and a Combination of Amphotericin B Lipid Formulation plus Caspofungin

Rhinocerebral mucormycosis in patients without predisposing medical conditions: a review of the literature

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