A Case of Rhinocerebral Mucormycosis with Acute Lymphocytic Leukemia

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  • Makihara Seiichiro
    Department of Otoralyngology Head and Neck Surgery, Kagawa Rosai Hospital
  • Ishihara Hisashi
    Department of Otoralyngology Head and Neck Surgery, Kagawa Rosai Hospital
  • Miyatake Tomomi
    Department of Otoralyngology Head and Neck Surgery, Kagawa Rosai Hospital
  • Tsumura Munechika
    Department of Otolaryngology Head and Neck Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
  • Noda Yohei
    Department of Otolaryngology Head and Neck Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
  • Higaki Takaya
    Department of Otolaryngology Head and Neck Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
  • Kariya Shin
    Department of Otolaryngology Head and Neck Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
  • Okano Mitsuhiro
    Department of Otolaryngology Head and Neck Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
  • Nishizaki Kazunori
    Department of Otolaryngology Head and Neck Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences

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Other Title
  • 急性リンパ性白血病の寛解導入療法中に発症した鼻脳型ムーコル症例

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Acute invasive fungal sinusitis is the most aggressive form of fungal sinusitis. It is seen in patients who are immunocompromised, and has a bad prognosis. The key to successful management is early and aggressive medical and surgical treatment. We report a case of rhinocerebral mucormycosis involving acute invasive fungal sinusitis with acute lymphocytic leukemia. After starting remission induction therapy for acute lymphocytic leukemia, a 74-year-old female started to have symptoms of visual loss in the left eye, left eyelid swelling, pain on the left side of the face and diplopia. CT scan demonstrated opacification of sinuses and left-eye proptosis. There was black eschar of the left nasal mucosa, and the biopsy of this mucosa showed mucormycosis. After diagnosis, she started to use liposomal amphotericin B as the systemic antifungal agent. We recommended extensive debridement of all infected and necrotic tissue, and orbital exenteration, but she and her family refused. She underwent endoscopic sinus debridement of necrotic tissue except for left orbital tissue, and local irrigation of sinus by amphotericin B was started. After the surgery, black eschar and perforation of her palate and saddle-nose deformity occurred. Finally, she died of bacterial pneumonia. Even if she had undergone extensive debridement of all infected and necrotic tissue, orbital exenteration and received systemic antifungal therapy, it would still have been very difficult to control this disease. We should make a prompt correct diagnosis of mucormycosis, and initiate appropriate therapies urgently.

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