J Rhinol.  2022 Jul;29(2):122-126. 10.18787/jr.2022.00410.

Rhino-Orbito-Cerebral Mucormycosis in an Immunocompromised Patient

• Cha HE
• Jeong JU
• Jung JH
• Kim ST

• KMID: 2532016
• DOI: http://doi.org/10.18787/jr.2022.00410

Abstract

Rhino-orbito-cerebral mucormycosis (ROCM) is an invasive fungal infection that usually occurs in immunocompromised patients. It is aggressive and has a high risk of mortality. With unclear guidelines, ROCM is treated in various ways. We present a patient who underwent kidney transplant and who treated for ROCM without major complications.

Keyword

Mucormycosis; Immunocompromised patient

Figure

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  Fig. 1 Preoperative patient’s face pictures. Left periorbital swelling was observed. A: Patient’s left nasal cavity. B: A bulging mass filling the left middle meatus.

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  Fig. 2 Pre-operative patient’s paranasal sinus computed tomography view. A: Coronal view. B: Axial view. The 3.4-cm heterogenous mass was located inside of left ethmoid sinus. The lesion was accompanied by left orbital medial wall erosion and involved the medial rectus mscule (indicated by stars). C, D: Pre-operative patient’s paranasal sinus magnetic resonance imaging T2-weighted view. C: The 8-mm rim enhanced lesion was observed in left. aspect of genu of the corpus callosum (indicated by arrow). D: The heterogeneous enhancing lesion inside the left ethmoid sinus has a clear boundary with the inside of the nasal cavity, but confirmed as a pattern invading the left orbital wall (indicated by star).

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  Fig. 3 Pathology of left. Nasal cavity lesion biopsy. A number of irregular shaped of ribbon-like hyphae are observed in H&E stain ×200 (A), GMS stain ×400 (B). H&E, Hematoxyling and Eosin; GMS, Grocott’s Methenamine Silver.

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  Fig. 4 Intra-operative. The dark brown mud-like discharge was shown from the inside of the ethmoid sinus. A: Necrotic granulation tissue with thick purulent discharge was attached to the cribriform plate and lamina papyracea. B: Three months after surgery, there were no abnormal findings on patient’s nasal cavity.

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  Fig. 5 Post-operative patient’s paranasal computed tomography view. A: Coronal view. B: Axial view. There is no lesion and no recurrence (indicated by stars). Nine months after treatment, the rim-enhanced lesion in left aspect of genu of the corpus callosum (indicated by arrow) (C) and ethmoid sinus (indicated by star) (D) was decreased compare with pre-operative magnetic resonance imaging.

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