Rhinocerebral mucormycosis with dissemination to pontine area in a diabetic patient: Treatment and management

Galletti, Bruno; Gazia, Francesco; Galletti, C; Perani, Fulvio; Ciodaro, Francesco; Freni, Francesco; Galletti, Francesco

doi:10.1002/ccr3.2255

Cited by 11 publications

(9 citation statements)

References 33 publications

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“…Rhinocerebral mucormycosis is a rare, aggressive, and life-threatening fungal infection [4], occurring most often in diabetes patients suffering from ketoacidosis [5]. At present, owing to the nonspeci c early-stage symptoms of this disease, it is di cult to diagnose until it is relatively advanced.…”

Section: Discussionmentioning

confidence: 99%

“…These symptoms can include prominent eyeballs, swelling and redness around the eyes, impaired eye movement, decreased vision, and potentially blindness. Nasal black eschar formation is one of the most important clinical ndings associated with rhinocerebral mucormycosis [4]. CT or magnetic resonance imaging (MRI) examinations of the skull generally reveal the thickening of the sinus mucosa, sinusitis, bone destruction, and cavernous sinus thrombosis.…”

Section: Discussionmentioning

confidence: 99%

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Rhinocerebral Mucormycosis Secondary to Severe Acute Pancreatitis and Diabetic Ketoacidosis: A Case Report

Wang

Luo³

et al. 2021

Preprint

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Introduction: Rhinocerebral mucormycosis is a rare and severe form of opportunistic fungal infection that can develop rapidly and cause significant mortality, particularly among diabetic patients suffering from ketoacidosis. Diagnosing rhinocerebral mucormycosis during the early stages of infection is challenging. Case presentation：We describe a case of rhinocerebral mucormycosis secondary to severe acute pancreatitis in a patient suffering from diabetic ketoacidosis. In this case, the condition was not diagnosed during the optimal treatment window. we therefore provide a thorough overview of related clinical findings and histopathological characteristics, and we discuss potential differential diagnoses.Conclusions: In summary, we described a case of rhinocerebral mucormycosis secondary to severe acute pancreatitis in a patient suffering from diabetic ketoacidosis, with the optimal treatment window for this condition having been missed. This report suggests that a definitive mucormycosis diagnosis can be made based upon tissue biopsy that reveals the presence of characteristic hyphae. Early diagnosis and treatment are essential in order to improve patient prognosis.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Rhinocerebral Mucormycosis Secondary to Severe Acute Pancreatitis and Diabetic Ketoacidosis: A Case Report

Wang

Luo³

et al. 2021

Preprint

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“…Other differential diagnoses are nasopharyngeal carcinoma, multiple myeloma, lymphoma and metastatic processes. [18][19][20][21] Among the imaging methods available to date, computed tomography (CT) is the most commonly used for the initial approach to the disease in question. It allows to quickly and relatively easily evaluate both the involvement of soft tissues and the degree of demineralization of the mastoid bone.…”

Section: Discussionmentioning

confidence: 99%

“…Other differential diagnoses are nasopharyngeal carcinoma, multiple myeloma, lymphoma and metastatic processes. 18 - 21 …”

Section: Discussionmentioning

confidence: 99%

From Uncommon Infection to Multi-Cranial Palsy: Malignant External Otitis Insights

et al. 2020

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Purpose: The progression of the otitic infectious process toward diseases of particular severity is often unpredictable, just as it is challenging to manage the patient over time, even after the apparent resolution of the disease. We aim to define a radiological reading key that allows us to correctly and promptly treat the disease, avoiding the possible severe complications. Methods: We conducted a retrospective study of 13 cases of basal cranial osteomyelitis (SBO) due to malignant external otitis, by the ENT Department of the University of Catania. Through a standardized approach and following the latest guidelines, we have evaluated all patients performing a standardized and personalized radiological protocol according to the stage of the patient’s pathology and modulating the treatment consequently. Results: Clinical signs have been observed such as otorrhea (100%), otalgia in 13/13 patients (100%), granulations in external auditory canal (100%), preauricular cellulitis in 9/13 patients (69%) headache 6/13 cases (46%), dysphonia 4/13 cases (31%). HRCT of the temporal bone proved useful in identifying even minimal bone lesions in 13/13 (100%) while improving MRI in vascular and nervous involvement, although in 1/13 patient with nerve palsy clinical symptomatology preceded radiological evidence. The 99mTc 3-phase planar bone scintigraphy was positive for SBO in 9/13 cases (69%) during the initial phase and, in 100% of the cases in images delayed to 2-3 hours. Subsequent checks up to 1 year, using the Ga 67 scintigraphy, excluded the presence of recurrences in 100% of patients. Conclusion: The osteomyelitis of the base of the skull is a severe complication of malignant external otitis, often not always easily diagnosed. Recurrence can occur up to 1 year after stopping therapy. Imaging techniques such as Tc and MRI are relevant for the initial diagnostic approach and the staging of the pathology and its complications. Nuclear medicine imaging plays a fundamental role in the evaluation of related osteoblastic activity, especially in the remission phase of the disease.

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“…Direct extension through bone destruction was excluded and occurs only in late stages of the disease process. 2 , 3…”

Section: Discussionmentioning

confidence: 99%

Intracranial brain parenchymal spread of mucormycosis through olfactory tract: a diffusion-weighted imaging-based concept

Sandron

Hantson

Duprez

2020

Acta Radiologica Open

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Mucormycosis is an opportunistic fungal infection involving among others the paranasal sinuses, nasal fossa and brain parenchyma. Mucor can invade the brain parenchyma by either contiguous spread from the paranasal sinuses or through vascular invasion. We report a case of fatal rhino-cerebral mucormycosis in whom cytotoxic edema at magnetic resonance diffusion-weighted imaging was symmetrically restricted to both neocortical and paleocortical primary areas of olfactory projection at earliest phase of the disease process. Shortly later tissue damage extended into the whole brain. This undescribed observation raised the hypothesis of preferential way of brain invasion by Mucor through the olfactory tract.

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Rhinocerebral mucormycosis with dissemination to pontine area in a diabetic patient: Treatment and management

Cited by 11 publications

References 33 publications

Rhinocerebral Mucormycosis Secondary to Severe Acute Pancreatitis and Diabetic Ketoacidosis: A Case Report

Rhinocerebral Mucormycosis Secondary to Severe Acute Pancreatitis and Diabetic Ketoacidosis: A Case Report

From Uncommon Infection to Multi-Cranial Palsy: Malignant External Otitis Insights

Intracranial brain parenchymal spread of mucormycosis through olfactory tract: a diffusion-weighted imaging-based concept

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