Rhino-orbital-cerebral mucormycosis and aspergillosis: differential diagnosis and treatment

• Published in: European archives of oto-rhino-laryngology Vol. 266; no. 1; pp. 71 - 76
• Main Authors: Arndt, Susan, Aschendorff, Antje, Echternach, Matthias, Daemmrich, Tanja Daniela, Maier, Wolfgang
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer-Verlag 01.01.2009; Springer
• Subjects: Aged; Aged, 80 and over; Antifungal Agents - therapeutic use; Antimicrobial agents; Aspergillosis - diagnosis; Aspergillosis - diagnostic imaging; Aspergillosis - drug therapy; Aspergillus; Biological and medical sciences; Diagnosis, Differential; Eye Infections, Fungal - diagnosis; Eye Infections, Fungal - diagnostic imaging; Eye Infections, Fungal - drug therapy; Follow-Up Studies; Head and Neck Surgery; Human mycoses; Humans; Immunocompromised Host; Infectious diseases; Magnetic Resonance Imaging; Male; Medical sciences; Medicine; Medicine & Public Health; Middle Aged; Miscellaneous mycoses; Mucorales - isolation & purification; Mucormycosis - diagnosis; Mucormycosis - diagnostic imaging; Mucormycosis - drug therapy; Mycoses; Neurosurgery; Orbital Diseases - diagnosis; Orbital Diseases - diagnostic imaging; Orbital Diseases - drug therapy; Orbital Diseases - mortality; Otorhinolaryngology; Otorhinolaryngology. Stomatology; Paranasal Sinus Diseases - diagnosis; Paranasal Sinus Diseases - diagnostic imaging; Paranasal Sinus Diseases - drug therapy; Paranasal Sinus Diseases - mortality; Phycomycoses; Rhinology; Risk Assessment; Sampling Studies; Severity of Illness Index; Survival Rate; Tomography, X-Ray Computed; Treatment Outcome; Tropical mycoses; Anterior skull base; Mucormycosis; Surgery of the paranasal sinuses; Opportunistic infections; Aspergillosis; Opportunistic infection; Mycosis; Anterior; ENT; Orbit (eye); Paranasal sinus; Differential diagnostic; Encephalon; Infection; Treatment; Surgery; Opportunistic infections, Anterior skull base, Surgery of the paranasal sinuses; Base of the skull
• ISSN: 0937-4477; 1434-4726
• DOI: 10.1007/s00405-008-0692-y

In immunocompromised patients, symptoms and the pathogen spectrum of sinusitis are frequently atypical. If progressive loss of vision occurs, an infection of the anterior skull base or nasal sinuses should be considered. We report on four patients with orbit-associated symptoms. CT-imaging revealed bony defects in sinus borders to orbits or endocranium. In all the cases immediate surgical drainage was performed because complications following sinusitis were suspected. Histopathological diagnosis revealed two cases of aspergillosis and mucormycosis. The possibility of opportunistic infections by saprophytic fungi must be taken into account in immunocompromised patients, as they may endanger both vision and survival. Immediate diagnosis and therapy are essential. Nowadays, therapeutic success can be achieved due to advances in antimicrobial therapy, hyperbaric oxygen therapy and treatment of the underlying disease. Radical procedures like orbital exenteration must be considered in all cases. The current state of diagnostics, therapy and prognosis is discussed based on these case reports and the recent literature.