Isolated Rhino-Orbital-Cerebral Mucormycosis. A Case Report and Literature Review

Case Report

Austin J Otolaryngol. 2015; 2(9): 1063.

Isolated Rhino-Orbital-Cerebral Mucormycosis. A Case Report and Literature Review

Barion U*, Cazzador D, Emanuelli E, Borsetto D, Alexandre E, Volo T, Pedruzzi B, Faccioli C, Prosenikliev V and Martini A

Department of Neuroscience, Padua University, Italy

*Corresponding author: Barion U, Department of Neuroscience, Operative Unit of Otolaryngology, Padua University, 35100, Italy

Received: August 25, 2015; Accepted: November 19, 2015; Published: November 21, 2015

Abstract

Mucormycosis represents an exceedingly rare invasive fungal infection, rapidly fatal if not promptly recognized and treated. Zygomycetes cause clinically relevant infections especially in elderly, diabetic or immunocompromised patients. Rhino-orbital-cerebral mucormycosis (M-ROC) is the most common form of zygomycosis. Despite therapeutic progresses, M-ROC is still characterized by high mortality rates, estimated between 35 and 66%. The objectives of this report are to describe a case of M-ROC in a 60-year-old woman presenting with asthenia and mild persistent fever and to review the literature related to the subject. After medical and surgical treatment, the patient is alive at 32-months follow-up. Only a high suspect of the disease and the alert for subtle clinical signs may lead to the prompt identification of Mucormycosis and to adequate medical and surgical management, resulting in improvement of the already poor prognosis of such an invasive infection.

Keywords: Mucormycosis; Rhino-orbital-cerebral mucormycosis; Invasive fungal sinusitis; Diabetic ketoacidosis

Abbreviations

M-ROC: Rhino-orbital-cerebral Mucormycoses; DKA: Diabetic Ketoacidosis; CT: Computed Tomography; MRI: Magnetic Resonance Imaging; ESS: Endoscopic Sinus Surgery; LAmB: Liposomal Amphotericin B; AmB: Amphotericin B

Case Presentation

A 60-year-old Caucasian woman presented to the Emergency Room of our Institution with severe asthenia and mild persistent fever. One week earlier she experienced poliuria and polidipsia associated with intensive productive cough and some isolated episodes of hemoptysis. She had a history of hypertension and grade III bronchial asthma, which last reported severe outbreak dated back to 30 days before. Due to her respiratory problem, the patient has been treated with oral corticosteroids for more than 2 years (which has been not regularly medically checked). Given the patient’s clinic and the laboratory findings, a diagnosis of diabetic ketoacidosis (DKA) and pulmonary infection was made and the patient was admitted to the Metabolic Disease Department of our Institution. The patient was treated with an antibiotic therapy (meropenem and Ampicillin/ sulbactam) associated with insulin and short-term injective steroid therapy.

Few days after the admittance, the patient complained of diplopia and numbness at the right side of the forehead skin. Fixed mydriasis and ptosis of the right eye were noticed at physical examination, thus the patient underwent ophthalmological evaluation, which reported a right rectus medialis muscle deficit. The fundoscopic eye exam showed a pale, atrophic papilla on the right side. The imaging - brain and head contrasted computed tomography (CT) scan and angiomagnetic resonance imaging (MRI) - showed a pansinusitis condition complicated with a right fronto-basal brain abscess and a right orbital abscess (Figure 1A,B). Nasal endoscopy found the presence of necrotic material, scabs and purulent exudates in the nasal cavity, suggesting the presence of an invasive fungal sinusitis (Figure 2).