Mucormycosis--clinical analysis of 12 cases
Tung, S.C.; Huang, H.S.; Huang, B.Y.; Lin, J.D.; Huang, M.J.; Wai, Y.Y.; Ryu, S.J.; Cheng, S.Y.
Journal of the Formosan Medical Association 87(4): 477-483
1988
ISSN/ISBN: 0371-7682 PMID: 3230391 Document Number: 308091
Mucormycosis is an uncommon, acute, and often fatal opportunistic fungal infection. The disease occurs most frequently in diabetics, and also in patients with leukemia, lymphoma, multiple myeloma, burn, uremia, and those undergoing cancer chemotherapy, organ transplantation with immunosuppressant therapy, or using antibiotics, or corticosteroids. Twelve patients who were admitted to the Chang Gung Memorial Hospital from January 1981 to January 1987 were pathologically proved to have mucormycosis. Most of them were diabetics (ten patients). There were eleven patients with a cephalic form of mucormycosis. The clinical manifestations included unilateral headache (64%), facial pain (46%), nasal discharge (55%), eye pain (46%), diplopia (18%), blindness (36%), ptosis (55%), exophthalmos (36%), and limitation of extraocular movement (64%). There were eight patients who had cloudy appearance of multiple paranasal sinuses demonstrated in plain roentgenograms. There were also seven patients who had increased density in multiple paranasal sinuses and focal bony destruction demonstrated by cranial computed tomography (CT). A high index of suspicion is necessary for the early detection of mucormycotic infection if above findings are presented in a diabetic patient. A thorough otolaryngological examination is essential. The average cumulative dose of amphotericin B for the 7 survivors in this series was 2,823 .+-. 1,034 mg (the 2 survivors who did not receive amphotericin B were excluded) with a mean duration of 85.6 .+-. 23.2 days of amphotericin B therapy. There were 7 patients who needed two or more surgical debridements. The treatment of mucormycosis is early diagnosis, control of the underlying disease (e.g. diabetes), systemic antifungal therapy, and aggressive surgical debridement whenever necessary.