Rhinocerebral mucormycosis (RM) is a rare, rapidly progressive disorder caused by fungi from the Mucoraceae family. With extensive central nervous system involvement, this disease is uniformly fatal within weeks. Mucormycosis normally presents in poorly controlled diabetics, intravenous drug abusers and immunocompromised patients. Many have advocated radical surgical resection (i.e. exenteration of the cavernous sinus with carotid sacrifice and en bloc resection) with administration of amphotericin B. We present a case of mucormycosis involving the paranasal sinuses and cranial base in a pediatric patient who experienced long-term survival with a more limited resection. We also present a review of the relevant literature. A 14-year-old diabetic male presented with RM with involvement of the bilateral frontal lobes, right basal ganglia and temporal lobe. Additionally, there was involvement of the sphenoid sinus and right cavernous sinus with extension into the posterior fossa along the course of the trigeminal nerve and encasement with narrowing of the right carotid artery. The patient underwent sinus endoscopy with debridement of necrotic fungal tissue and bone. This was followed by craniotomy with evacuation of bifrontal, right temporal and basal ganglia abscesses in such a way that all abscess cavities communicated. An Ommaya reservoir was placed into the largest cavity. The patient continued to receive intrathecal and intravenous antibiotics as well as hyperbaric oxygen therapy. The patient was clinically and radiographically free of disease 1 year after diagnosis. While invasive RM is generally a fatal disease, this rare disorder can be treated successfully without radical resection, particularly if multimodality treatment options are implemented.

Hussain S, Salahuddin N, Ahmad I, Salahuddin I, Jooma R: Rhinocerebral invasive mycosis: Occurrence in immunocompetent individuals. Eur J Radiol 1995;20:151–155.
Gregory J, Golden A, Haymaker W: Mucormycosis of the central nervous system: Report of three cases. Bull Johns Hopkins Hosp 1943;73:405–419.
Harris JS: Mucormycosis: A report of a case. Pediatrics 1955;16:857–867.
Chick EW, Evans J, Baker RD: Treatment of mucormycosis in rabbits with amphotericin B. Antibiot Chemother 1958;8:394–397.
Alleyne C, Vishteh A, Speltzler R, Detweiler P: Long-term survival of a patient with invasive cranial base rhinocerebral mucormycosis treated with combined endovascular, surgical, and medical therapies: Case report. Neurosurgery 1999;45:1461–1464.
Adler D, Milhorat T, Miller J: Treatment of rhinocerebral mucormycosis with intravenous, interstitial, and cerebrospinal fluid administration of amphotericin B: Case report. Neurosurgery 1998;42:644–649.
Blitzer A, Lawson W, Meyers B, Biller H: Patient survival in paranasal mucormycosis. Laryngoscope 1980;90:635–648.
Jahrsdoerfer R, Ejercito V, Johns M, Cantreller W, Sydney D: Aspergillosis of the nose and the paranasal sinuses. Am J Otolaryngol 1979;1:6–14.
Cotran R, Kumar V, Robbins S: Fungal, protozoal and helminthic disease and sarcoidosis; in Cotran RS, Kumar V, Collins T, Robbins SL, Schmitt B (eds): Robbins Pathological Basis of Disease. Philadelphia, Saunders, 1989, pp 385–390.
Calli C, Savas R, Parildar M, Pekindil G, Alper H, Yunten N: Isolated infarction due to rhinocerebral mucormycosis. Neuroradiology 1999;41:179–181.
Karsner H, Saphir O: Influence of high partial pressures of oxygen on the growth of certain molds. J Infect Dis 1926;39:231–236.
Ferguson BJ, Mitchell TG, Moon R, Camporesi EM, Farmer J: Adjunctive hyperbaric oxygen for treatment of rhinocerebral mucormycosis. Rev Infect Dis 1988;10:551–559.
Price J, Stevens D: Hyperbaric oxygen in the treatment of rhinocerebral mucormycosis. Laryngoscope 1980;90:737–747.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.