CHRONIC RHINOCEREBRAL MUCORMYCOSIS

Rhinocerebral mucormycosis is a well-described fulminant fungal infect ion that typically presents acutely in patients with diabetic ketoacid osis or immunosuppression. Chronic presentations of rhinocerebral muco rmycosis have also been described. In the chronic infection, the disea se course is indolent and slowly progressive, often occurring over wee ks to months. The authors report 2 cases of chronic rhinocerebral muco rmycosis (CRM) treated at their institution and review 16 other cases reported in the English-language literature. In these cases, the media n time from symptom onset to diagnosis was 7 months. The most common p resenting features of CRM are ophthalmologic and include ptosis, propt osis, visual loss, and ophthalmoplegia. CRM occurs predominantly in pa tients with diabetes and ketoacidosis. The incidence of internal carot id artery and cavernous sinus thrombosis is higher in CRM patients tha n in those with the acute disease, although the overall survival rate for CRM patients is 83%. GRIM is clinically distinct from chronic Ento mophthorales infection.