Arif Raza Khan, Mohib Ullah Khan, Saeed Ullah, Hidayat Ullah, Javed Shah.
Rhinocerebral mucormycosis.
J Coll Physicians Surg Pak Jan ;12(10):639-41.

Rhinocerebral mucormycosis is an aggressive opportunistic infection which appears in cerebral, pulmonary, ocular, superficial and disseminated forms Rhinocerebral disease is the commonest form.

Case Report: A 60 years old man presented to E.N.T. Unit of Hayatabad Medical Complex, Peshawar in June 2000, with dizzy spells, nasal obstruction and pain in right ear. There was swelling of right eye with loss of vision and right facial paralysis. On clinical examination there was soft tissue mass occupying the whole right nasal cavity with ulceration of hard palate on right side. No mass was visible on posterior rhinoscopy, there was right sided complete ophthalmoplegia. He was known diabetic and hypertensive. His random blood sugar was 300mg/dl, urine contained albumin and sugar with few red cells, pus cells, and epithelial casts. Blood urea was 132 mg% and serum creatinine was 4.3mg%. Erythrocytes sedimentation rate was 100mm at first hour. Abdominal ultrasound showed no visceromegaly. CT Scan of paranasal sinuses and brain showed a mass in right maxillary sinus and right posterior ethmoid air cells, there was thickening of the soft tissue in the preseptal area and inferior aspect of right eyeball with proptosis. No intracranial extension of the lesion was noted, the brain parenchyma and ventricular system appeared intact. Figure 4,5 These appearances were suggestive of infective process. Biopsy was taken from the mass in right maxillary sinus through intranasal antrostomy. The histopathology of the material showed fragments of necrotic slough and inflammatory tissue. There were strap like non-septate fungal hyphae, few ring like cut sections of these hyphae were also seen and candida spores and hyphae were also seen separately. These findings were consistent with mucormycosis, whereas candidal infection appeared to be a superadded infection and no evidence of malignancy was seen in the sections examined. The disease from right side of the nose and maxillary sinus was removed through lateral rhinotomy approach and all the material curretted from the sinus and nose. If the lesion was confined to nose and ethmoidal sinuses then the role of ethmoidectomy was considered, but the disease was extended to maxillary sinus and orbit in addition to nose and ethmoids. Later on we planned to enucleate the right eyeball as mucormycosis is a rapidly narcotizing infection but the patient refused to enucleate the eyeball. The patient was put on oral fluconazole at the dose of 300 mg on first day followed by 150 mg daily for at least 6 weeks. The patient did not come back for follow up.

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