LONG-TERM SURVIVAL IN RHINOCEREBRAL MUCORMYCOSIS - CASE-REPORT

Mucormycosis refers to a group of rapidly progressive infections cause d by fungi belonging to the order Mucorales. Infection most often deve lops in individuals with immunological or metabolic compromise, althou gh patients without underlying abnormalities have been affected. Speci fic clinical manifestations are associated with various predisposing f actors. Rhinocerebral mucormycosis is the most common form and most fr equently develops in individuals with poorly controlled diabetes melli tus. The extent of anatomical involvement and clinical course are unpr edictable, depending on the intrinsic factors of the host. Over the pa st 20 years the prognosis for patients with rhinocerebral mucormycosis , once considered to be a uniformly fatal disease, has improved. Coord inated medical and surgical treatment, including rapid diagnosis, the advent of systemic antifungal agents, aggressive surgical debridement, and control of the underlying disease process, have been credited wit h its successful management. The range of survival rates recorded with the regimen of combined therapies is wide because the number of patie nts reported is limited and anatomical involvement is diverse. Surviva l with intracerebral abscess is rare. The authors describe the success ful management of a patient who developed a bifrontal fungal abscess d uring treatment for rhinocerebral mucormycosis associated with ketoaci dosis and diabetes mellitus. The patient remains without radiographic or clinical evidence of infection more than 2 years after treatment. T he authors review the characteristic clinical, radiographic, and patho logical features of previously reported infections and emphasize the i mportance of early detection and aggressive treatment in the managemen t of this frequently fulminant and fatal disease.