Clinical features of rhinocerebral mucormycosis with cranial nerves involvement: report of 8 cases

Abstract

Objective To summarize the clinical features and outcomes of patients with rhinocerebral mucormycosis involving cranial nerve. Methods and Results Eight pathologic confirmed cases of rhinocerebral mucormycosis with cranial nerves involvement since February 2012 to January 2020 were collected and evaluated. All patients were diagnosed at Beijing Tongren Hospital, Capital Medical University. The main clinical manifestations were headache, eye and face swelling. In addition to the paranasal sinuses, the ocular motor nerve, extraocular muscle, meninges, brain parenchyma, optic nerve, cerebrovascular and vestibulocochlear nerve were also involved. There were 5 patients with the primary disease of type 2 diabetes mellitus, one patient with acute leukemia receiving chemotherapy, one patient with severe aplastic anemia receiving immunosuppressive therapy, and one patient with craniocerebral trauma. Six patients were confirmed by pathological biopsy of paranasal sinus mucosa, the other 2 patients underwent brain parenchymal biopsy and temporal muscle biopsy respectively. In addition to one patient with meningeal involvement who gave up treatment and finally died, the other 7 patients received amphotericin B (one case was combined with posaconazole) or amphotericin B liposome antifungal therapy. Among them 4 patients underwent simultaneous transnasal endoscopic radical lesion removal treatment and 3 patients with brain parenchymal involvement died despite of active treatment. Conclusions The mortality of rhinocerebral mucormycosis with brain parenchyma involvement is extremely high. For patients with sinusitis with immunocompromised state, if there is acute progression of cranial nerve involvement, swelling around the eyes and headache, attention should be paid to the identification of the disease, and antifungal drugs and combined surgery treatment should be given early. Pathological biopsy of the affected mucosal tissue is the first choice for quick diagnosis.

Keywords

• mucormycosis
• nose diseases
• brain diseases
• cranial nerves
• biopsy