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[Phinocerebral mucormycosis--report of a case]
A Hayashi1, K Makino, T Morimitsu
1Department of Otolaryngology, Miyazaki Medical College.
Abstract:
Rhinocerebral mucormycosis is a rare and fatal deep fungus infection occurring in debilitated patients. Its reports have been recently increased because of the increase of such conditions as uncontrolled diabetics, leukemia, and cancer. A 60-year-old male suffering from continuous headache and fever was diagnosed as meningitis, and repeated culture of cerebrospinal fluid was negative. Antibiotic therapy was ineffective. CT scan revealed brain abscess in the right frontal lobe and bone defect over the right posterior ethmoidal sinuses. Both maxillary and ethmoidal sinuses were operated on 38 years ago. The patient was suspected to have rhinologic brain abscess. We intended to remove the source of infection in the right posterior ethmoidal sinuses beneath the base of the skull and to repair the defect of dura mater. The operation was tried on the 6th hospital day. There was a cyst in the posterior ethmoidal sinuses and an intact denuded dura mater over the cyst. The causative organism was not detected by smear test, bacteriological and fungal culture. He relapsed into lethargy, and died on the 21st hospital day due to the vast cerebral infarction. Autopsy revealed rhinocerebral mucormycosis. The literature on this disease was also reviewed and discussed.
Insights
Rhinocerebral mucormycosis, a rare fungal infection, can be fatal in immunocompromised patients. This case highlights the diagnostic challenges and fatal outcome of a patient with a brain abscess due to this condition.
Area of Science:
- Infectious Diseases
- Mycology
- Neurology
Background:
- Rhinocerebral mucormycosis is a rare, aggressive fungal infection.
- Increased incidence linked to uncontrolled diabetes, leukemia, and cancer.
- Often fatal, particularly in debilitated patients.
Observation:
- A 60-year-old male presented with headache and fever, initially diagnosed as meningitis.
- Cerebrospinal fluid cultures were negative, and antibiotic therapy failed.
- CT revealed a brain abscess and ethmoidal sinus bone defect; prior sinus surgery noted.
Findings:
- Surgical exploration identified a cyst in the posterior ethmoidal sinuses.
- Causative organism not detected by initial smear, bacterial, or fungal cultures.
- Autopsy confirmed rhinocerebral mucormycosis as the cause of death.
Implications:
- This case underscores the difficulty in diagnosing deep fungal infections like mucormycosis.
- Highlights the importance of considering fungal etiologies in refractory infections.
- Emphasizes the aggressive nature and high mortality rate of rhinocerebral mucormycosis.