Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
권호 표지
DOI QR코드

DOI QR Code

Successful Treatment of a Case with Rhino-Orbital-Cerebral Mucormycosis by the Combination of Neurosurgical Intervention and the Sequential Use of Amphotericin Band Posaconazole

  • Yoon, Young-Kyung (Division of Infectious Diseases, College of Medicine, Korea University) ;
  • Kim, Min-Ja (Division of Infectious Diseases, College of Medicine, Korea University) ;
  • Chung, Yang-Gu (Departments of Internal Medicine, Neurosurgery, College of Medicine, Korea University) ;
  • Shin, Il-Young (Departments of Internal Medicine, Neurosurgery, College of Medicine, Korea University)
  • Published : 2010.01.28
Download PDF
⟨ Previous Next ⟩

Abstract

Rhino-orbital-cerebral (ROC) mucormycosis is an uncommon, acute and aggressive fungal infection. It remains a challenging problem to clinicians despite aggressive debridement surgery and antifungal therapy. The authors describe a case of ROC mucormycosis with pericranial abscess occurring in a female patient with uncontrolled diabetes mellitus. The infection initially developed in the right-sided nasal sinus and later progressed through the paranasal sinuses with the invasion of the peri-orbital and frontotemporal region, due to the delayed diagnosis and treatment. Numerous non-septate hyphae of the zygomycetes were identified by a punch biopsy from the nasal cavity and by an open biopsy of the involved dura. The patient was treated successfully with extensive debridement of her necrotic skull and surrounding tissues, drainage of her pericranial abscess and antifungal therapy, including intravenous amphotericin B for 61 days and oral posaconazole for the following 26 days. She returned to a normal life and has had no recurrence since the end of her treatment 15 months ago.

Keywords

References

  1. Bhansali A, Bhadada S, Sharma A, Suresh V, Gupta A, Singh P, et al. : Presentation and outcome of rhino-orbital-cerebral mucormycosis in patients with diabetes. Postgrad Med J 80 : 670-674, 2004 https://doi.org/10.1136/pgmj.2003.016030
  2. Chakrabarti A, Das A, Mandal J, Shivaprakash MR, George VK, Tarai B, et al. : The rising trend of invasive zygomycosis in patients with uncontrolled diabetes mellitus. Med Mycol 44 : 335-342, 2006 https://doi.org/10.1080/13693780500464930
  3. Chakrabarti A, Das A, Sharma A, Panda N, Das S, Gupta KL, et al. : Ten years' experience in zygomycosis at a tertiary care centre in India. J Infect 42 : 261-266, 2001 https://doi.org/10.1053/jinf.2001.0831
  4. Choi HY, Lew JM : Rhinocerebral mucormycosis combined with brain abscess. J Korean Soc Plast Reconstr Surg 16: 363-371, 1989
  5. deShazo RD, Chapin K, Swain RE : Fungal sinusitis. N Engl J Med 337 : 254-259, 1997 https://doi.org/10.1056/NEJM199707243370407
  6. Diekema DJ, Messer SA, Hollis RJ, Jones RN, Pfaller MA : Activities of caspofungin, itraconazole, posaconazole, ravuconazole, voriconazole, and amphotericin B against 448 recent clinical isolates of filamentous fungi. J Clin Microbiol 41 : 3623-3626, 2003 https://doi.org/10.1128/JCM.41.8.3623-3626.2003
  7. Han SR, Choi CY, Joo M, Whang CJ : Isolated cerebral mucormycosis. J Korean Neurosurg Soc 42 : 400-402, 2007 https://doi.org/10.3340/jkns.2007.42.5.400
  8. Jeong H, Kang PJ, Lee JY, Cha KS, Lee ID, Son DH, et al. : A case of rhinocerebral mucormycois associated with diabetes mellitus. Korean J Med 39 : 715-720, 1990
  9. Kim HJ, Choung YH, Cho MJ, Baik SS : Clinical analysis of eight cases of mucormycosis. J Clin Otolaryngol 15 : 134-138, 2004
  10. Lee CH, Jinn TH, Choi HY, Kim JY : Two cases of rhinocerebral mucormycosis. Korean J Otorhinolaryngol-Head Neck Surg 32 : 139-144, 1989
  11. Marom T, Watad W, Dan M, Roth Y : Posaconazole for boneinvading rhinomaxillary mucormycosis. Otolaryngol Head Neck Surg 140 : 610-611, 2009 https://doi.org/10.1016/j.otohns.2008.11.022
  12. McNulty JS : Rhinocerebral mucormycosis : predisposing factors. Laryngoscope 92 : 1140-1143, 1982
  13. Peterson KL, Wang M, Canalis RF, Abemayor E : Rhinocerebral mucormycosis : evolution of the disease and treatment options. Laryngoscope 107 : 855-862, 1997 https://doi.org/10.1097/00005537-199707000-00004
  14. Reed C, Bryant R, Ibrahim AS, Edwards J Jr, Filler SG, Goldberg R, et al. : Combination polyene-caspofungin treatment of rhino-orbitalcerebral mucormycosis. Clin Infect Dis 47 : 364-371, 2008 https://doi.org/10.1086/589857
  15. Rickerts V, Atta J, Herrmann S, Jacobi V, Lambrecht E, Bialek R, et al. : Successful treatment of disseminated mucormycosis with a combination of liposomal amphotericin B and posaconazole in a patient with acute myeloid leukaemia. Mycoses 49 Suppl 1 : 27-30, 2006
  16. Roden MM, Zaoutis TE, Buchanan WL, Knudsen TA, Sarkisova TA, Schaufele RL, et al. : Epidemiology and outcome of zygomycosis : a review of 929 reported cases. Clin Infect Dis 41 : 634-653, 2005 https://doi.org/10.1086/432579
  17. Rogers TR : Treatment of zygomycosis: current and new options. J Antimicrob Chemother 61 Suppl 1: i35-i40, 2008
  18. Scully EP, Baden LR, Katz JT : Fungal brain infections. Curr Opin Neurol 21 : 347-352, 2008 https://doi.org/10.1097/WCO.0b013e3282fee95b
  19. Spellberg B, Edwards J Jr, Ibrahim A : Novel perspectives on mucormycosis : pathophysiology, presentation, and management. Clin Microbiol Rev 18 : 556-569, 2005 https://doi.org/10.1128/CMR.18.3.556-569.2005
  20. Spellberg B, Walsh TJ, Kontoyiannis DP, Edwards J Jr, Ibrahim AS : Recent advances in the management of mucormycosis: from bench to bedside. Clin Infect Dis 48 : 1743-1751, 2009 https://doi.org/10.1086/599105
  21. Tarani L, Costantino F, Notheis G, Wintergerst U, Venditti M, Di Biasi C, et al. : Long-term posaconazole treatment and follow-up of rhino-orbital-cerebral mucormycosis in a diabetic girl. Pediatr Diabetes 10 : 289-293, 2009 https://doi.org/10.1111/j.1399-5448.2008.00465.x
  22. van Burik JA, Hare RS, Solomon HF, Corrado ML, Kontoyiannis DP : Posaconazole is effective as salvage therapy in zygomycosis : a retrospective summary of 91 cases. Clin Infect Dis 42 : e61-e65, 2006 https://doi.org/10.1086/500212
  23. Yohai RA, Bullock JD, Aziz AA, Markert RJ : Survival factors in rhino-orbital-cerebral mucormycosis. Surv Ophthalmol 39 : 3-22, 1994 https://doi.org/10.1016/S0039-6257(05)80041-4

Cited by

  1. Rhino-orbital Mucormycosis Treated Successfully with Posaconazole without Exenteration vol.37, pp.5, 2013, https://doi.org/10.3109/01658107.2013.809463
  2. Posaconazole Treatment in Korea: Single-Center Experience Over 5 Years vol.54, pp.5, 2010, https://doi.org/10.3349/ymj.2013.54.5.1234
  3. Successful Treatment of Rhino-Orbital Mucormycosis with Posaconazole after Combination of Surgical Treatment and Amphotericin B vol.56, pp.6, 2010, https://doi.org/10.3341/jkos.2015.56.6.956
  4. An aggressive multidisciplinary approach reduces mortality in rhinocerebral mucormycosis vol.7, pp.1, 2010, https://doi.org/10.4103/2152-7806.182964
  5. Rapidly progressive rhino-orbito-cerebral mucormycosis in a patient with type 2 diabetes: A case report vol.13, pp.3, 2010, https://doi.org/10.3892/etm.2017.4074
  6. Epidemiology, clinical features, diagnosis and treatment of cerebral mucormycosis in diabetic patients: A systematic review of case reports and case series vol.63, pp.12, 2020, https://doi.org/10.1111/myc.13187