A Case of Rhinoorbital Mucormycosis in a Leukemic Patient with a Literature Review from Turkey

• Published in: Mycopathologia (1975) 2011-11, Vol.172 (5), p.397-405
• Main Authors: Gumral, Ramazan, Yıldızoglu, Uzeyir, Saracli, Mehmet Ali, Kaptan, Kursat, Tosun, Fuat, Yildiran, Sinasi Taner
• Format: Article
• Language: English
• Subjects: Acute lymphatic leukemia; Adult; Amphotericin B; Amphotericin B - administration & dosage; Amphotericin B - therapeutic use; Antifungal Agents - administration & dosage; Antifungal Agents - therapeutic use; Antiparasitic agents; Base Sequence; Biomedical and Life Sciences; Care and treatment; Case reports; Chemotherapy; Computed tomography; Diabetes; Diabetes mellitus; DNA, Fungal - genetics; Endoscopy; Eukaryotic Microbiology; Fungal infections; Health aspects; Humans; Infection; Invasiveness; Leukemia; Life Sciences; Literature reviews; Lung; Male; Malignancy; Medical Microbiology; Microbial Ecology; Microbiology; Mortality; Mucor; Mucor circinelloides; Mucorales; Mucormycosis; Mucormycosis - complications; Mucormycosis - diagnosis; Mucormycosis - drug therapy; Mucormycosis - pathology; Neutropenia; Nose; Paranasal Sinus Diseases - complications; Paranasal Sinus Diseases - diagnosis; Paranasal Sinus Diseases - drug therapy; Paranasal Sinus Diseases - pathology; Paranasal Sinuses - microbiology; Paranasal Sinuses - pathology; Plant Sciences; Precursor Cell Lymphoblastic Leukemia-Lymphoma - complications; Prognosis; Rhizomucor; Rhizopus; Rhizopus - drug effects; Rhizopus - genetics; Rhizopus - isolation & purification; Rhizopus - pathogenicity; Rhizopus oryzae; Risk factors; RNA, Ribosomal, 5.8S; Sequence Analysis, DNA; Sinus; Sinuses; Surgery; Tomography; Turkey; Turkish literature; Zygomycosis
• ISSN: 0301-486X; 1573-0832
• DOI: 10.1007/s11046-011-9449-z

Mucormycosis (Zygomycosis) is a rare, invasive, opportunistic fungal infection of the paranasal sinuses, caused by a fungus of the order Mucorales. We report a case of rhinoorbital mucormycosis caused by Rhizopus oryzae in an acute lymphoblastic leukemia patient and review the 79 Mucormycosis cases reported in the last decade from Turkey. In our case, the diagnosis was made with endoscopic appearance, computerized tomography of the paranasal sinuses, and culture of the surgical materials. Following aggressive surgical debridement and parenteral amphotericin B therapy, the patient recovered completely. In Turkish literature, rhinocerebral manifestations were the most common form of the mucormycosis (64 cases), followed by pulmonary form (6 cases). The most common risk factor was hematologic malignancies (32 cases) and diabetes mellitus (32 cases), similar to those reported from the rest of the world. The etiologic agents responsible for the review cases were Rhizopus sp., Mucor spp., Rhizomucor spp., Rhizopus oryzae , Mucor circinelloides , and Lichtheimia corymbifera . Although various treatment modalities were used, amphotericin B was the mainstay of therapy. Mortality rate was found to be 49.4% in review cases. It seems that strong clinical suspicion and early diagnosis, along with aggressive antifungal therapy and endoscopic sinus surgery, have great importance for better prognosis in mucormycosis.