Rhinocerebral and systemic mucormycosis. Clinical experience with 36 cases

• Published in: Journal of the Neurological Sciences 1996-11, Vol.143 (1), p.19-30
• Main Authors: Rangel-Guerra, Ricardo A, Martínez, Héctor R, Sáenz, Corando, Bosques-Padilla, Francisco, Estrada-Bellmann, Ingrid
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Amphotericin B; Biological and medical sciences; Brain Diseases - diagnostic imaging; Brain Diseases - microbiology; Brain Diseases - surgery; Debridement; Ent and stomatologic mycoses; Female; Fluconazole; Fungal infection; Human mycoses; Humans; Infant; Infectious diseases; Magnetic Resonance Imaging; Male; Medical sciences; Middle Aged; Mucormycosis; Mucormycosis - diagnostic imaging; Mucormycosis - pathology; Mucormycosis - surgery; Mycoses; Retrospective Studies; Rhinitis - diagnostic imaging; Rhinitis - microbiology; Rhinitis - surgery; Rhinocerebral; Tomography, X-Ray Computed; Tropical medicine; Unstable diabetes; Zygomycetes
• ISSN: 0022-510X; 1878-5883
• DOI: 10.1016/S0022-510X(96)00148-7

We analysed retrospectively our clinical experience with 36 cases of mucormycosis. They were seen during the last 15 years. The diagnosis suspected on clinical grounds, was confirmed in 31 cases by finding the hyphae in hematoxylin-eosin stained material obtained from aspirated or tissue biopsy or by isolation of the fungus in culture. Rhinocerebral mucormycosis was diagnosed in 22 patients. Diabetes was the underlying disorder in 20 cases, kidney failure in one and myelodysplastic syndrome in one. Nine had stable and 11 unstable diabetes (ketoacidosis in 10 and hyperosmolar coma in 1). The earliest sign was facial edema, followed by proptosis, chemosis and extraocular muscle paresis. They were treated by extensive surgical debridement, insulin and antifungal drugs with 69% of survival rate. The disseminated mucormycosis was diagnosed at the autopsy in 5 cases, acute leukemia was the underlying disease in 2 of them. Pulmonary mucormycosis was diagnosed in 2 cases, cutaneous form in 2, sinuorbital form in 4 and brain abscess in one patient. Eight of these 9 cases survived after therapy. We emphasize the importance of an early diagnosis. This can only be made in the presence of a typical clinical setting confirmed by finding the hyphae in tissue or culture. Antifungal drugs along with treatment of the underlying disorder and aggressive surgical debridement must follow.