RHINOCEREBRAL AND SYSTEMIC MUCORMYCOSIS - CLINICAL-EXPERIENCE WITH 36CASES

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.