[Rhinocerebral mucormycosis during deferoxamine therapy]

A 24-year-old woman had been in full remission of an acute myeloid leukaemia since 1988, but she required regular erythrocyte and platelet transfusions for pancytopenia. To counteract a progressive siderophilia due to the transfusions (ferritin levels of about 10,000 ng/ml) deferoxamine was intermittently given intravenously (5 g after each transfusion). Seven months after the start of this treatment the patient was hospitalized because of severe left-sided facial pain as well as reddening and swelling in the periorbital region. As maxillary and frontal sinusitis was suspected, antibiotics were administered (at first three times daily 2.2 g amoxicillin and clavulanic acid, then two times daily 300 mg rifampicin and 200 mg ciprofloxacin). Nonetheless, orbital phlegmon developed within a few days with protrusion and blindness of the left eye necessitating a decompression operation. Material obtained at operation revealed rhinocerebral mucormycosis. After 3 weeks of antimycotic treatment with both amphotericin B (1 mg/kg.d) and flucytosine (150 mg/kg.d) the mucormycosis healed without the necessity of extensive and disfiguring removal of necrotic tissue. But the blindness in the left eye, caused by occlusion of the central artery, was irreversible.