SUCCESSFUL MEDICAL AND ANTIFUNGAL THERAPY OF RHIZOPUS-ORYZAE RHINO-CEREBRAL MUCORMYCOSIS WITHOUT SURGICAL-TREATMENT

Precise modalities of rhinocerebral mucormycosis therapy remain unknow n and evolution of these mycosis is often fatal. We report the results of a successful therapy of a mycosis with very extensive involvement in a 75-year-old diabetic man. The patient was followed during 3 years . Surgical incision was discussed and not used because it was impossib le to remove all necrosed tissue. However, diabetic ketoacidosis corre ction and iv administration of amphotericin B permitted a rapid and an unexpected amelioration. Eight months later, alternative per os thera py was decided and in vitro susceptibility tests were used to determin e which antifungal to administer. The evolution of tissular lesion was checked over with serial computed tomography and resonance imaging sc ans and the therapy was associated with iterative tests of drug serum concentration. It was surprising that susceptibility tests showed in v itro resistance to amphotericin B in spite of favorable clinical resul ts; the fungus was also resistant to itraconazole and sensitive to ket oconazole. Dosages of this agent of 400 mg. daily was used. Although a ntifungal serum concentrations revealed lower level than necessary, th e same regimen was undergone for fourteen months and recovery obtained without relaps. In this case-report, it should be possible that under lying diseases treatment (diabetes and ketoacidosis) was the main fact or of successful therapy, then, the use of ketoconazole for treatment of mucormycosis wouldn't have been evaluated. The decision to differ s urgical excision probably contribued to the complete cure without neur ologic after-effect, although surgical incision is considered as the m ost important option of treatment in order to ensure the mortality rat e due to mucormycosis.