[Risk Factors for Mortality in Rhino-Orbito-Cerebral Mucormycosis Cases]

Mucormycosis is a rare, difficult-to-diagnose, angioinvasive fungal disease with high morbidity and mortality. It is classified into clinical categories based on the anatomical regions involved. The most common clinical form is rhino-orbito-cerebral mucormycosis (ROCM). In this study, we aimed to identify the risk factors for mortality in cases of rhino-orbito-cerebral mucormycosis (ROCM). We retrospectively evaluated histopathologically and/or microbiologically confirmed ROCM cases in patients over the age of 18, diagnosed in our clinic between January 1, 2003, and December 31, 2024. A total of 49 patients were diagnosed as ROCM, with a mean age of 56.6 ± 15.5 years, including 22 women (44.9%) and 27 men (55.1%). Patients had diabetes mellitus (65.3%), hematological cancer (24.4%), hematopoietic stem cell transplantation (10.2%), chronic kidney failure (8.1%), solid organ transplantation (8.1%), and solid organ cancer (8.1%). Predisposing factors among the patients included steroid treatment (32.6%), erythrocyte transfusion (26.5%), recent tooth extraction (20.4%), neutropenia (18.3%) and a recent history of coronavirus disease-2019 (12.2%). Periocular pain (81.6%), ophthalmoplegia (75.5%), periorbital cellulitis (69.3%) and ptosis (67.3%) were identified as the most common presenting symptoms and clinical findings. Although antifungal therapy (liposomal amphotericin B), functional endoscopic sinus surgery (FESS) and orbital exenteration were performed when necessary, 24 patients (48.9%) died. Binary logistic regression analysis revealed that the risk of mortality was significantly higher in patients with hematological malignancy (8.2-fold), those receiving steroid therapy (5.2-fold), those undergoing chemotherapy or immunosuppressive treatment (10-fold) and those who received erythrocyte transfusion (9.8-fold). Additionally, patients presenting with orbital apex syndrome (3.5-fold), those with cerebral infarction (6.9-fold) and those whose duration from symptom onset to FESS exceeded 96 hours (4-fold) also had a significantly increased risk of death. As a result, underlying hematological malignancy, immunosuppressive therapy, steroid use, erythrocyte transfusion, the presence of orbital apex syndrome at admission, cerebral infarction and delayed surgical intervention were all found to increase the risk of mortality.