Surgical management of rhinocerebral mucormycosis: A case series
Mette Stueland Wolthers, MD, PhD,
Grethe Schmidt, MD,
Caroline Asirvatham Gjørup, MD, PhD,
Jannik Helweg-Larsen, MD, DMSc,
Niclas Rubek, MD,
Lisa Toft Jensen, MD
Affiliations
Mette Stueland Wolthers, MD, PhD
Department of Plastic Surgery and Burns Treatment, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
Grethe Schmidt, MD
Department of Plastic Surgery and Burns Treatment, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
Caroline Asirvatham Gjørup, MD, PhD
Department of Plastic Surgery and Burns Treatment, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Corresponding author: Caroline Asirvatham Gjorup, Department of Plastic Surgery and Burns Treatment, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, DK-2100 København Ø, Denmark
Jannik Helweg-Larsen, MD, DMSc
Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
Niclas Rubek, MD
Department of Otorhinolaryngology, Head and Neck Surgery & Audiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
Lisa Toft Jensen, MD
Department of Plastic Surgery and Burns Treatment, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
Rhinocerebral mucormycosis (RCM) is a rare and rapidly progressive, destructive, angioinvasive fungal infection, which primarily affects immunocompromised patients. A high suspicion is required to diagnose RCM as initial clinical manifestations are often nonspecific. A cornerstone of the management is early diagnosis and radical surgery, which often requires complex reconstructive procedures.The optimal timing of reconstructive surgery is controversial.This case series presents the reconstructive perspective on four RCM cases treated with aggressive debridement, targeted antifungal treatment, and hyperbaric oxygen therapy followed by an early local flap or microsurgical reconstruction – to enable adequate local blood perfusion, antifungal treatment, and to decrease the risk of secondary infection. In all four patients, the early reconstructive surgery was successful without relapse of RCM or flap failure.We suggest aggressive surgical debridement till clear resection margins are obtained based on histopathology and/or microbiology, at a point which reconstructive surgery can be performed safely.
