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Successful Management of Rhinocerebral Mucormycosis With Frontal Bone Invasion in a Steroid-Induced Immunocompromised
Jong Seung Kim1,2, Gwang Min Chae2,3, Jin Yong Shin2,3
1Department of Otorhinolaryngology-Head and Neck Surgery, Medical School of Jeonbuk National University.
Abstract:
Rhinocerebral mucormycosis is a rare but life-threatening fungal infection that progresses rapidly, particularly in immunocompromised patients. The authors report a case of a 65-year-old female with no prior history of diabetes or malignancy who developed invasive mucormycosis following corticosteroid treatment for immune thrombocytopenia. The infection extended from the nasal cavity through the cribriform plate into the frontal bone and dura mater. Initial endoscopic debridement with nasoseptal flap reconstruction was followed by a second-stage bicoronal resection and titanium plate reconstruction due to progressive bony invasion. Histopathology confirmed mucormycosis with angioinvasive hyphae. The patient was successfully treated with staged surgery and systemic liposomal amphotericin B, showing full recovery without recurrence at 6 months. This case highlights the importance of early recognition, aggressive surgical management, and multidisciplinary care in immunocompromised patients with atypical presentations of mucormycosis.
Insights
Rhinocerebral mucormycosis, a severe fungal infection, can rapidly spread in immunocompromised individuals. Early surgical intervention and antifungal therapy are crucial for successful outcomes in complex cases.
Area of Science:
- Mycology
- Infectious Diseases
- Neurosurgery
Background:
- Rhinocerebral mucormycosis is a rare, aggressive fungal infection.
- It poses a significant threat, especially to immunocompromised patients.
- Corticosteroid use can predispose individuals to this infection, even without prior comorbidities.
Purpose of the Study:
- To report a case of invasive rhinocerebral mucormycosis.
- To illustrate the challenges in diagnosing and managing atypical presentations.
- To emphasize the importance of multidisciplinary care in such cases.
Main Methods:
- A 65-year-old female patient with immune thrombocytopenia treated with corticosteroids developed invasive mucormycosis.
- The infection extended from the nasal cavity to the frontal bone and dura mater.
- Treatment involved staged surgical debridement and reconstruction, alongside systemic liposomal amphotericin B.
Main Results:
- Histopathology confirmed angioinvasive mucormycosis.
- The patient underwent successful staged surgical interventions, including endoscopic debridement and bicoronal resection with titanium reconstruction.
- Complete recovery was achieved with no recurrence at 6 months post-treatment.
Conclusions:
- Early recognition and aggressive surgical management are vital for invasive mucormycosis.
- Multidisciplinary collaboration is essential for optimizing patient outcomes.
- This case underscores the need for vigilance in immunocompromised patients presenting with unusual symptoms.
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