Ra. Rangelguerra et al., RHINOCEREBRAL AND SYSTEMIC MUCORMYCOSIS - CLINICAL-EXPERIENCE WITH 36CASES, Journal of the neurological sciences, 143(1-2), 1996, pp. 19-30
We analysed retrospectively our clinical experience with 36 cases of m
ucormycosis. They were seen during the last 15 years. The diagnosis su
spected on clinical grounds, was confirmed in 31 cases by finding the
hyphae in hematoxylin-eosin stained material obtained from aspirated o
r tissue biopsy or by isolation of the fungus in culture. Rhinocerebra
l mucormycosis was diagnosed in 22 patients. Diabetes was the underlyi
ng disorder in 20 cases, kidney failure in one and myelodysplastic syn
drome in one. Nine had stable and 11 unstable diabetes (ketoacidosis i
n 10 and hyperosmolar coma in 1). The earliest sign was facial edema,
followed by proptosis, chemosis and extraocular muscle paresis. They w
ere treated by extensive surgical debridement, insulin and antifungal
drugs with 69% of survival rate. The disseminated mucormycosis was dia
gnosed at the autopsy in 5 cases, acute leukemia was the underlying di
sease in 2 of them. Pulmonary mucormycosis was diagnosed in 2 cases, c
utaneous form in 2, sinuorbital form in 4 and brain abscess in one pat
ient. Eight of these 9 cases survived after therapy. We emphasize the
importance of an early diagnosis. This can only be made in the presenc
e of a typical clinical setting confirmed by finding the hyphae in tis
sue or culture. Antifungal drugs along with treatment of the underlyin
g disorder and aggressive surgical debridement must follow.