Rhinosinusal mucormycosis: Literature review and some particular cases

Abstract

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.

Factors associated with survival in diabetic patients with rhino-orbito-cerebral mucormycosis

“…Surgical debridement is part of the cornerstone of the treatment. Hargrove et al also report that patients with the same symptoms and the same risk factors, but in whom the exenteration of the eyeball is practiced, have a higher survival rate 7,8 .…”