Rhino-orbital-cerebral mucormycosis: a review.
Rhino-orbital-cerebral mucormycosis (ROCM) is an acute, often fatal, fungal infection caused by members of the class Zygomycetes and the order Mucorales. The genus Rhizopus accounts for most cases of ROCM. The disease is characterized by fungal hyphal invasion of blood vessels resulting in thrombosis and infarction of the nasal, paranasal sinus, orbital, and cerebral tissues. The most commonly associated condition is diabetes mellitus; other associated conditions include immunocompromised states, renal disease, deferoxamine use, and acidotic states. Common clinical findings include rhinitis, periorbital and facial swelling, facial and mucosal necrosis, ophthalmoplegia, multiple cranial nerve palsies, facial pain, and headache. Definitive diagnosis is made by demonstration of fungal hyphae in tissue specimens. The mainstay of treatment is aggressive surgical debridement of infected tissue and administration of amphotericin B. ROCM has a mortality rate of 40-50%; 70% of survivors are left with residual defects. Early diagnosis and treatment are imperative in the successful management of patients afflicted with this devastating sight- and life-threatening disease.