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PubMed2004

[The clinical and pathological features of rhinocerebral mucormycosis].

OBJECTIVE: To investigate the clinical and pathological features of rhinocerebral mucormycosis. METHODS: The clinical data of three cases of mucormycosis were collected and analyzed. Pathological examination was conducted by autopsy or biopsy. RESULTS: All the three cases of mucormycosis had diabetic ketoacidosis. The early symptoms were fever, periocular and temporal headache. Gradually, orbital apex syndrome, periocular skin cellulitis and necrosis developed. Examination of nose revealed black necrotic turbinates. Meningeal signs and hemiplegia may also occur. Frontal hemorrhagic infarction was seen in pathology. A large amount of mucor fungi were found in the mucosa of nasal sinuses necrotic brain tissue under microscope. CONCLUSIONS: Rhinocerebral mucormycosis is a rare complication which was mainly seen in patients with diabetic ketoacidosis. The lesion invaded nose, eyes and brain with a high mortality.

Biopsy↗
PubMed2005

[Cutaneous mucormycosis and diabetes: about one observation].

Mucormycosis is a rare opportunistic infection but a fulminant disease. Varying clinical forms have been described, including cutaneous localisations which are mainly observed in diabetic and burned patients. The cutaneous lesions induced by the mucormycosis affection are often atypical and gangrenous. We report a case of cutaneous mucormycosis in a Tunisian patient with diabetic ketoacidosis. He developed cutaneous necrotic lesions at the low limb. The diagnosis of mucormycosis was not initially evoked but tardily confirmed by identifying mucorale hyphae in tissue sections and Rhizopus oryzae in the sample culture. The treatment consisted of an extensive surgical debridement associated with intravenous perfusion of amphotericin B. The patient had a fatal outcome.

Adult↗
PubMed2005

An unusual localization of mucormycosis diagnosed by fine needle aspiration cytology: a case report.

Mucormycosis is an uncommon fungal infection, occurring mainly in patients with acidosis, chronic illnesses and malignancies. The most frequent site of involvement in patients of hematological malignancies is the respiratory tract. Isolated subcutaneous localization of mucormycosis in such patients is extremely rare. We report a case of a young patient of non-Hodgkin's lymphoma on chemotherapy who presented with a subcutaneous swelling on the anterior aspect of right thigh. Fine needle aspiration cytology (FNAC) smears from the swelling revealed numerous characteristic broad, irregularly contoured and pleomorphic hyphae of mucormycosis. This fungus seldom grows in culture and confirmation of the diagnosis depends on cytological or histological examination of infected tissues. Our case report documents a rare site of isolated mucormycosis infection and emphasizes the role of FNAC as a simple, rapid, accurate, and useful method of diagnosing fungal infections.

Adolescent↗
PubMed2006

Successful management of cerebral and pulmonary mucormycosis with liposomal amphotericin B in a 28-year-old woman with acute lymphoblastic leukemia.

A 28-year-old woman with acute lymphoblastic leukemia developed fever and unilateral pleural based pulmonary infiltrate during prolonged chemotherapy induced neutropenia. CT-guided lung biopsy confirmed the diagnosis of pulmonary mucormycosis and liposomal amphotericin B therapy was started. A few days after the initial symptoms, the patient developed convulsions and a brain abscess was detected in computerized tomography and magnetic resonance imaging. Fungal hyphae detected in histopathological examination of a brain biopsy had identical morphology with those seen in previous lung biopsies. The patient was treated with liposomal amphotericin B for five months and cytotoxic chemotherapy was successfully completed during antifungal therapy. Pulmonary infiltrates and the brain abscess resolved and the patient received an allogeneic bone marrow transplantation from a matched, unrelated donor. Antifungal therapy was continued for one additional month after bone marrow transplantation to prevent a relapse of invasive mucormycosis. Follow-up of the patient revealed no signs of relapse of invasive mucormycosis but two months after successful bone marrow transplantation the patient developed lethal cytomegalovirus pneumonitis which was confirmed by autopsy. No signs of mucormycosis were detected at post-mortem.

Adult↗
PubMed1991

[Adjunctive treatment with hyperbaric oxygen in a patient with rhino-sinuso-orbital mucormycosis].

Mucormycosis (phycomycosis) is an acute and often fatal infection, mostly seen in diabetics and immunocompromised patients, and seldom in healthy people. Therapy includes aggressive surgical debridement, amphotericin B and control of underlying predisposing condition (diabetes, immunosuppression or immunodeficiency). The rhino-sinuso-orbital presentation is typically observed in insulin-dependent diabetes mellitus with ketoacidosis. This metabolic condition may impair the polymorphonuclear function in a reversible way and this may favour infection by a mucoral. These spores germinate into hyphae, which invade local arteries and arterioles, causing thrombosis, vascular insufficiency and tissue hypoxia and acidosis, conditions which further enhance fungal growth. Hyperbaric oxygen has theoretical value in treating mucormycosis, since it reduces tissue hypoxia caused by the vascular insufficiency. We report an insulin-dependent diabetic patient with rhino-sinuso-orbital mucormycosis, who after being treated with amphotericin B and surgical debridement on two occasions, maintained clinical and tomographic evidence of active infection, and mucoral persistence in the lesion. An aggressive surgical debridement, using microsurgical techniques, was performed. Amphotericin B was increased up to a total dose of 3900 mg. (he had previously received 2900 mg) and hyperbaric oxygen was added as adjunctive treatment. The outcome was successful. There was no evidence of relapse after a 16-month follow-up. This observation would confirm the usefulness of hyperbaric oxygen as adjunctive therapy in mucormycosis.

Adult↗
PubMed1989

[A case report of rhinocerebral mucormycosis in hemodialysis patient receiving deferoxamine].

Deferoxamine (DFO) has been widely used in the treatment of aluminum toxicity in patients on chronic dialysis. Mucormycosis is an opportunistic infection caused by fungi of the Mucorales order and some reports suggested a role for DFO in the precipitation of this infection. A 50-year-old man had been on hemodialysis for 16 years. 6 weeks before admission, he was begun on DFO because of aluminum toxicity. 2 weeks before admission, general fatigue and fever developed and followed by headache and loss of vision. He was admitted to this hospital with disturbed consciousness. His clinical course and a CT scan of the head suggested cerebral infarction. Within 24 hours he required ventilatory support and died 5 days after the admission. On autopsy, rhino-cerebral mucormycosis was demonstrated with a mycotic thrombus involving the left middle cerebral artery. Dialysis-related mucormycosis has recently appeared in the literature. We feel that hemodialysis patients on DFO may be at risk for potentially fatal mucormycosis infections. With a possible relationship between DFO treatment and this fatal opportunistic infection, caution should be given before using this drug and the indications should be definitive.

Brain Diseases↗
PubMed1993

Mucormycosis in the BMT population.

Mucormycosis is known to cause rhinocerebral and pulmonary disease in patients with diabetes, leukemia, and lymphoma. However, the characteristics and outcome of these infections have not been well described in the BMT population. In a 17-year consecutive series of BMT patients, 13 of 1500 patients (0.9%) developed mucormycosis. Ten of the transplants were allogeneic and three autologous. Six infections occurred within 90 days of transplant, and six occurred at or within several days of autopsy. Seven patients were neutropenic and another patient had just engrafted at diagnosis of infection. Sites of infection were lung-brain (n = 4), sinonasal region (n = 3), lung (n = 2), disseminated (n = 2), lung-kidney (n = 1), and bone-muscle (n = 1). All patients were treated with prolonged amphotericin B therapy. Surgical debridement was employed in the three sinonasal infections. Death from mucormycosis occurred in ten of 13 (77%) patients. Two patients are alive, including one who had resolution of sinonasal infection. Mucormycosis may occur in both neutropenic and non-neutropenic patients, and may occur long after hospital discharge for BMT. These infections are often fatal, although patients with limited sinonasal disease may have a better prognosis, especially with early diagnosis and aggressive antifungal therapy.

Adolescent↗
PubMedDate not supplied

Subacute mucormycosis with secondary internal carotid occlusion: clinical and MR findings.

A case of subacute mucormycosis with a cavernous sinus syndrome and internal carotid occlusion with survival after surgical and anfothericin B treatment in a patient with type II diabetes is reported. The RM images of this form of evolution of the infection by mucormycosis is also described. We suggest that a mucormycosis with subacute profile is possible in a well controlled patient with an underlying inmunosuppressive disorder, and that this form of mucormycosis should be considered in the differential diagnosis of the destructive lesions of the middle line, as a prompt identification of this disorder can improve the survival rate of patients.

Acute Disease↗
PubMedDate not supplied

Hepatic mucormycosis in a child with fulminant hepatic failure.

Mucormycosis is an uncommon, opportunistic infection in children. We present a case of fulminant hepatic failure with hepatic mucormycosis. Although the suggested defects and pathogenic mechanisms in infections related to hepatic failure and mucormycosis are similar, few cases with both mucormycosis and liver failure have been reported.

Autopsy↗
PubMed1997

Mucormycosis in diabetes.

Mucormycosis is a rare opportunistic infection caused by ubiquitous fungi typically found in soil, spoiled foods, bread, and dust. The acute infection most commonly is rhinocerebral and is associated with metabolic acidosis. Mucormycosis spreads quickly and can progress from the paranasal area to the brain in a few days. In the case presented, a young diabetic woman had diabetic ketoacidosis and classic signs and symptoms of mucormycosis. Even after aggressive and appropriate treatment with surgical debridement and IV administration of amphotericin B, the fungus invaded the central nervous system. This article discusses current methods of treating mucormycosis and important critical care nursing considerations for patients who have the infection.

Adult↗
PubMed1998

[A case of rhinocerebral mucormycosis presenting orbital apex syndrome].

A 62-year-old man with untreated diabetes complained of diplopia and headache. Neurological examination demonstrated left abducens nerve palsy. MRI showed a mass lesion in the left orbital apex. Total left ophthalmoplegia and visual loss rapidly developed in the next two weeks. A craniotomy was performed to decompress the orbital apex and remove the mass. The optic nerve was tightly encased by fibrous tissue. The pathological diagnosis was mucormycosis. Systemic administration of amphotericin B and fluconazole was started immediately. But the lesion rapidly invaded the cavernous sinus and occluded the left internal carotid artery. Finally, the patient died with intracranial extension of mucormycosis four months after the operation. Rhinocerebral mucormycosis is a rapidly progressive fatal disease. Successful treatment seems to be based on early diagnosis, control of the underlying disease, radical surgical resection, and systemic administration of amphotericin B. Mucormycosis should be considered as a differential diagnosis of orbital apex syndrome.

Amphotericin B↗
PubMed1996

Rhinocerebral mucormycosis. Therapy with amphotericin B lipid complex.

Rhinocerebral mucormycosis with intracranial involvement has a high mortality. The standard therapy consists of aggressive surgical débridement accompanied by high doses of amphotericin B deoxycholate. Even with this therapy, the mortality rate has been 48% in the series reported since 1980. We treated a 60-year-old diabetic woman with rhinocerebral mucormycosis involving the cavernous sinus whose infection responded to medical therapy with amphotericin B lipid complex. To our knowledge, this is the only well-documented medical cure of a patient with rhinocerebral mucormycosis and intracranial involvement.

Amphotericin B↗
PubMed1985

Mucormycosis. Report of 11 cases.

Mucormycosis is fulminant fungal infection that usually occurs in debilitated patients with an underlying pathologic condition. The common clinical types include rhinocerebral, pulmonary, disseminated, and intestinal forms. This report describes 11 cases seen in our institution since 1970. Of nine patients with underlying diabetes mellitus, eight developed rhinocerebral mucormycosis and one had the cutaneous form. Two additional patients with acute leukemia showed the disseminated and pulmonary forms of mucormycosis. In nine patients, the diagnosis was established by histologic appearance and by culture of infected tissue obtained by biopsy. In two patients the diagnosis was made during postmortem examination. Five patients survived. We have emphasized the importance of early diagnosis and prompt, appropriate medical and surgical therapy to obtain a significant survival rate in patients with this frequently fatal disease.

Adolescent↗
PubMed1988

Bilateral cavernous sinus thrombosis due to mucormycosis.

A 49-year-old man requiring hemodialysis for end-stage renal disease developed orbital cellulitis and bilateral central retinal artery occlusions. Although cranial computed tomography demonstrated ethmoid and sphenoid sinusitis, two surgical biopsy specimens of sinus mucosa were nondiagnostic. Autopsy findings confirmed cerebral mucormycosis with bilateral cavernous sinus and carotid artery thrombosis. The patient had been taking deferoxamine for hemochromatosis, and this chelating agent may have been the predisposing factor in developing mucormycosis. We discuss the limitations of current neuroimaging techniques in establishing the diagnosis of both cerebral mucormycosis and cavernous sinus thrombosis.

Brain Diseases↗
PubMed1979

Acute subdural hematoma and intracerebral hemorrhage. Rare complications of rhinocerebral mucormycosis.

Rhinocerebral mucormycosis is a short-term and often rapidly lethal fungal disease. It is generally seen in uncontrolled cases of diabetes with ketoacidosis. This case exhibits many of the features of a typical fulminating rhinocerebral mucormycosis. However, the fatal complications of acute subdural hematoma and massive intracerebral hemorrhage due to rupture of aneurysm, as demonstrated by angiography, are unique clinical manifestations of patients with rhinocerebral mucormycosis.

Antifungal Agents↗
PubMed1986

Survival after intestinal mucormycosis in acute myelogenous leukemia.

A young woman with acute myelocytic leukemia developed acute lower gastrointestinal bleeding immediately after a first remission induction of her leukemia. After the site of bleeding was located in the descending colon, a necrotic bleeding ulcer was resected. Histologic examination of the ulcer established the diagnosis of gastrointestinal mucormycosis. Treatment with amphotericin B was administered because of the high risk of dissemination. The patient has been followed for 9 months with no evidence of relapse of infection. Survival after gastrointestinal mucormycosis in acute leukemia has not previously been reported in the English language literature. Success in managing mucormycosis depends on the adherence to the recommended principles of early aggressive diagnostic measures, excisional surgery, amphotericin B therapy, and control of the underlying predisposing condition.

Adult↗
PubMed1991

Gastrointestinal mucormycosis.

Twenty patients with gastrointestinal mucormycosis are reviewed. This often fatal opportunistic fungal infection was diagnosed histologically, and was categorized as colonization (five patients), infiltration (seven patients), or vascular invasion (eight patients). There were no fatalities from colonization. In 10 patients, mucormycosis complicated peptic ulcer disease. Seven of these patients had infiltrative or invasive disease. The presentation and operative findings mimicked malignancy in five of these seven patients, and six had successful surgical intervention. The other patient was cured by medical therapy alone. Ten patients had infection associated with other gastrointestinal diseases: post-traumatic peritonitis (four patients), transmural amoebiasis (two patients), tuberculosis (one patient), gastroenteritis (one patient), gastric carcinoma (one patient) and diabetes (one patient). Eight patients had significant infection and only one survived. In this series, mucormycosis had a less aggressive course when complicating peptic ulcer than when it occurred in association with other gut diseases.

Gastrointestinal Diseases↗
PubMed2004

Tracheal mucormycosis presented as an intraluminal soft tissue mass.

BACKGROUND: Mucormycosis is a potentially lethal disease caused by an opportunistic fungal infection. It occurs mostly in diabetic or immunosuppressed patients and usually involves the lungs or paranasal sinuses. METHODS: We report a rare case of a patient with diabetic ketoacidosis who presented with progressive cough and dyspnea. CT of the neck and chest showed an intraluminal soft-tissue mass extending from the first tracheal ring to the thoracic inlet, causing severe destruction of the trachea. Direct laryngoscopy and biopsy demonstrated hyphal invasion with architecture typical of invasive mucormycosis. RESULTS: The patient underwent resection of the upper trachea and prolonged amphotericin B therapy and is disease free at 24 months after surgery. CONCLUSIONS: In patients with diabetes presenting with progressive hoarseness, dyspnea, and endobronchial mass, a fungal infection should be considered. In case of invasive tracheal mucormycosis, prompt diagnosis and early surgical resection may help improve survival.

Cough↗