Mucormycosis is a fulminant fungal infection occurring in debilitated patients having an underlying pathological condition. A case of extensive rhinocerebral mucormycosis with associated brain abscess which occurring in a diabetic female is presented. Numerous broad nonseptate hyphae of mucor were obtained from initial bilateral nasal cavity punch biopsies. Infection began in the nose and progressed through the paranasal sinuses, with secondary invasion of the orbit and CNS. Successful treatment involved correction of metabolic ketacidosis, amphotericin B therapy, extensive debridement and surgical drainage of the brain abscess. The patient eventually returned to her normal life and was without recurrence after one year.
Rhinocerebral mucormycosis is a fulminating fungal infection that occrus primarily in patients with poorly controlled diabetes [8, 18, 25, 26]. It can also occur as a pulmonary or disseminated form in nondiabetic immunosuppressed patients [1, 2, 3, 13, 14, 19, 22], in patients with burns [4, 23, 26], in noncompromised patients [5], after the use of immunosuppressive drugs for therapy, especially of neoplasia such as leukemia and lymphoma [20] and in patients receiving renal transplantation [10, 12]. Gastrointestinal mucormycosis usually occurs in patients with Ksashiorkor, malnutrition, amebiasis or uremia. Eisenberg et al (18) reported central nervous system (CNS) mucormycosis apparently due to intravenous introdection of the fungi of extension of rhinocerebral disease; endocarkitis and vascular mucormycosis usually follow open heart surgery. In recent years, increased physician awareness has led to earlier diagnosis of rhinocerebral mucormycosis. This, together with aggressive surgical therapy, in combination with intravenous amphotericin B, has led to improved cure rates. Frequently, the ophthalmologist is first to consider the diagnosis due to inadequate intranasal examination by the primary physician. The occurrence of the orbital manifestations is late and thus survival rates can be poor despite vigorous therapy. Death rates remain high if direct CNS invasion is found at the initial examination. A review of the relevant literature has revealed only three cases of survival from rhinocerebral mucormycosis associated with brain abscess [9, 11, 27].
|