Rhinosinusal mucormycosis is a life-threatening disease caused by fungus of the order Mucorales, which commonly affects individuals with diabetes and those in immunocompromised states. It is the most common form of mucormycosis with a high mortality rate (50-80%). Treatment options include reversal of the underlying risk factors when it is possible, systemic antifungal medication and radical surgical debridement. Prognosis is reserved because of the high potential of invasiveness, so diagnosis and early treatment are essential. Herein, we make a review about the most important features of this pathology and we report two cases of rhinosinusal mucormycosis with similar presentations who followed the same treatment protocol – extended surgical debridement of the necrotic tissue combined with systemic antifungal treatment (Amphotericin B). Complete recovery was achieved in one patient, whereas in the other one, due to late presentation, massive extension and incomplete surgical debridement, the disease was complicated with multiple organ dysfunction and cerebral stroke. By presenting these cases, we would like to point out the importance of early diagnosis, appropriate medical and surgical therapy to obtain a significant survival rate in patients with this fatal disease.

BACKGROUND. Coronavirus disease 2019 (COVID-19) is one of the main global health problems of the twenty-first century, with more than one-hundred million people infected and more than two million deaths. The immunosuppression caused by SARS-CoV-2 infection along with steroidal treatment, hyperglycaemia and elevated ferritin levels creates the perfect environment for opportunistic infections such as mucormycosis. COVID-19-associated mucormycosis carries a high mortality rate. Therefore, in addition to antifungal therapy and aggressive surgical debridement of necrotic tissue, strategies to improve glycaemic index is the key factor in order to obtain a favourable outcome. MATERIAL AND METHODS. For the purpose of this article, the PubMed databases were searched using MeSH descriptors and the Boolean operator “AND” for the terms “rhinosinusal” and “mucormycosis” and “diabetes”, between February 2019 – December 2021. Clinical characteristics, therapy and outcome data were gathered and compared to what has previously been reported in the literature. Also, we report the case of a 68-year-old patient with uncontrolled type 2 diabetes mellitus, who developed mucormycosis during post-COVID period, to underline the need of early detection of this potentially deadly fungal illness. RESULTS. The clinical and imaging evaluation revealed no evidence of disease recurrence, at one- and two-months’ follow-ups. CONCLUSION. In this context, we would like to emphasize the importance of a high index of suspicion for mucormycosis in patients with COVID-19 infection, with pre-existing medical disorders, presenting with rhino-orbital or rhino-cerebral symptomatology.

Olfactory neuroblastoma (ONB), also known as esthesioneuroblastoma, is a rare malignant neuroectodermal tumor originating primarily from the basal layer of the olfactory epithelium in the roof of the nasal cavity. The most common symptoms are nasal obstruction, anosmia, recurrent epistaxis, rhinorrhea and excessive lacrimation. Imaging studies are helpful for assessing the extent of olfactory neuroblastoma, as well as grading the tumor. The definitive diagnosis is based on histopathological exam and immunohistochemistry profile and it might be quite challenging because the tumor can mimic other sinonasal malignancies. Because of the small number of reported cases and the lack of prospective research, the optimal treatment for olfactory neuroblastoma is still controversial. However, it is generally believed that surgical resection followed by radiotherapy gives the best outcome in terms of recurrence and survival rates. Keeping in mind the rarity of olfactory neuroblastoma and the diagnostic difficulty, the aim of this study is to improve the understanding of the clinical features by reviewing the literature focusing on the recent advances in the diagnosis and treatment of ONB. Moreover, we are reporting an atypical case of an aggressive type of olfactory neuroblastoma treated through a multimodal approach, with no signs of tumor recurrence after a 3-month follow-up.