By Daniel Todd, MD
Rhinocerebral mucormycosis is a rare opportunistic infection of the sinuses, nasal passages, oral cavity, and brain caused by saprophytic fungi. The infection can rapidly result in death. Rhinocerebral mucormycosis commonly affects individuals with diabetes and those in immunocompromised states.
Diagnosis is made by clinical evaluation and biopsy of tissue with histopathological evaluation. The tissue can be sent in formalin. It is best to discuss this with the pathologist.
Prognosis is best correlated with reversal of the underlying susceptibility. Establishing immune competence with GSF’s or Neupogen is paramount.
Surgical removal, almost oncologic has been touted. However, less extensive approaches can often be successful. Again, the underlying immune status is paramount.
Hyperbaric oxygen therapy is very promising and should be considered.
Systemic antifungals are to be started intravenously and immediately. Liposomal Amphoterocin B has been the gold standard. Posaconazole is a newer agent with promise.