Rhinocerebral Mucormycosis: A Ten-Year Single Centre Case Series.

Abstract

IntroductionRhinocerebral mucormycosis (RCM) is a rare, frequently lethal, opportunistic infection of the paranasal sinuses and brain caused by fungi of the Mucoracea family. The overall global incidence is low, with the condition most commonly found in India and the Middle East. Early diagnosis and aggressive treatment are essential. Overall mortality is high; reported rates range from 25-60%. Its infrequent presentation can pose both diagnostic and therapeutic challenges for centers not familiar with the condition.ObjectiveWe aimed to evaluate patient demographics, clinical presentation, diagnosis, management, and the complications of this uncommon condition.MethodsWe carried out a retrospective case-series analysis of all patients with a confirmed diagnosis of RCM presenting to a single tertiary-level hospital between 2000-2010. Hospital patient records were used to attain the specific clinical details for each case.ResultsA total of nine patients (eight males and one female) were diagnosed with RCM during this period. All patients had diabetes mellitus; the mean age was 58.2 years. The most common presenting features were foul-smelling blood-stained rhinorrhoea (100%), nasal congestion (100%), reduced visual acuity (89%), and hard palate ulceration (67%). Two patients had a cerebral abscess at presentation; two patients had skull base erosions with associated cranial nerve palsies. All patients received systemic amphotericin B and surgical debridement. The overall mortality rate was 78%.ConclusionsRhinocerebral mucormycosis is a notoriously difficult infection to treat. Our case series demonstrates how patients often present late with a disease that has already spread beyond the paranasal sinuses. Despite treatment with antifungals and extensive surgical debridement, mortality remains high.