Rhino-orbital-cerebral mycoses (Mucormycosis and Phaeohyphomycosis): A case series

Rhino-orbital-cerebral mycoses are caused by different type of fungus. Mucormycosis is frequently an acute, aggressive opportunistic infection associated with high morbidity and mortality, in immunocompromised patients. In contrast, some Phaeohyphomycosis such as Drechslera hawaiiensis can affect young, immunocompetent patients. In Mexico, the high prevalence of poorly controlled diabetes mellitus, and limited access to specialized healthcare, constitute risk factors for mucormycosis.

It was a retrospective study made up by a series of cases which are presented. All rhino-orbital-cerebral mycosis (excluding aspergillosis) diagnosed at our institution between 2019 and 2025 were included. Clinical, radiological and histopathological features were analyzed.

Seven mucormycosis and one Phaeohyphomycosis cases were analyzed. Mucormycosis: Rhino-orbital-cerebral form (n=2), rhino-orbital form (n=4), and one, sino-nasal-suprasellar case. The clinical evolution was: Acute, rapidly progressing type (71.4%) and subchronic/chronic (28.6%). One chronic case presented as a pseudotumor. Mortality was 14.3% (1/7). Most patients required combined surgical debridement and systemic antifungal therapy. Phaeohyphomycosis: A 26-year-old immunocompetent male was infected by D. hawaiiensis; he had a heterogeneous lesion at the skull base; differential diagnoses included clival chordoma and esthesioneuroblastoma.

Rhino-orbital-cerebral fungal infections may exhibit a broad clinical spectrum; mucormycosis can present as a fulminant case or even as a pseudotumor with evolution over years. D. hawaiiensis can cause infection in immunocompetent individuals. Physicians and dentists should maintain a high index of suspicion for fungal infections in patients with progressive sinonasal or facial disease.