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Chronic rhinocerebral mucormycosis
W C Harrill1, M G Stewart, A G Lee
1Department of Otolarynology and Communicative Sciences, Baylor College of Medicine, Houston, TX 77030, USA.
Abstract:
Rhinocerebral mucormycosis is a well-described fulminant fungal infection that typically presents acutely in patients with diabetic ketoacidosis or immunosuppression. Chronic presentations of rhinocerebral mucormycosis have also been described. In the chronic infection, the disease course is indolent and slowly progressive, often occurring over weeks to months. The authors report 2 cases of chronic rhinocerebral mucormycosis (CRM) treated at their institution and review 16 other cases reported in the English-language literature. In these cases, the median time from symptom onset to diagnosis was 7 months. The most common presenting features of CRM are ophthalmologic and include ptosis, proptosis, visual loss, and ophthalmoplegia. CRM occurs predominantly in patients with diabetes and ketoacidosis. The incidence of internal carotid artery and cavernous sinus thrombosis is higher in CRM patients than in those with the acute disease, although the overall survival rate for CRM patients is 83%. CRM is clinically distinct from chronic Entomophthorales infection.
Insights
Chronic rhinocerebral mucormycosis (CRM) presents indolently over months, primarily in diabetic patients. Ophthalmic symptoms are common, but survival rates remain high despite increased thrombosis risk.
Area of Science:
- Mycology
- Infectious Diseases
- Ophthalmology
Background:
- Rhinocerebral mucormycosis (CRM) is a severe fungal infection.
- It often presents acutely in immunocompromised or diabetic ketoacidosis patients.
- Chronic presentations are less common but described.
Observation:
- This study reviews 18 cases of chronic rhinocerebral mucormycosis.
- The median time to diagnosis was 7 months.
- Ophthalmologic symptoms like ptosis and visual loss were most common.
Findings:
- Chronic rhinocerebral mucormycosis predominantly affects diabetic patients.
- Internal carotid artery and cavernous sinus thrombosis occurred more frequently.
- The overall survival rate for chronic rhinocerebral mucormycosis was 83%.
Implications:
- Chronic rhinocerebral mucormycosis is clinically distinct from acute presentations and other fungal infections.
- Early recognition of indolent symptoms is crucial for timely diagnosis and management.
- Despite complications, a high survival rate suggests effective treatment strategies exist.