Mucormycoses: when a fungus becomes a lethal threat

Introduction Mucormycosis is a rare but often fulminant disease. It is an angioinvasive fungal infection that particularly affects immunocompromised patients. The most common form is the rhinoorbitocerebral form, which is caused by the fungus Rhizopus oryzeus. In this case, the spores enter the paranasal sinuses via the nose and spread from there hematogenously into the orbit and cerebral tissue. Local necrosis, visual loss and cranial nerve deficits and even lethal courses may occur.

Material/Methods Within 14 days 3 patients with suspected orbital mucormycosis were presented to the ENT-Clinic of the University of Heidelberg. All patients had a hemato-oncologic disease and presented with orbitalphlegmones and acute sinusitis. All patients underwent sinus surgery, in patient 2 we also performed an exenteratio orbitae, and patient 3 also underwent a radical resection of the hard palate. Intraoperative findings included necrosis and hemorrhage of the sinunasal mucosa. Histologically, mucormycosis was detected in all patients. Postoperative antibiotic and antifungal therapy was given. Patient 1 and 2 died in the short term. Patient 3 stabilized postoperatively. Summary The present case reports illustrate the severity of the clinical picture of mucormycosis. Immunosuppressed patients are predominantly affected. Acute facial swelling within sinusitis in immunocompromised patients should also be considered as mucormycosis. As illustrated in the present cases, immediate radical surgical intervention is required for prognosis and further outcome.

Publication History

Article published online:
12 May 2023