Fact-sheet: Rhinocerebral mucormycosis


Updated on 03/28/2019 at 9:34 AM

Note : 0/10
Share

View all RADEOS cases associated with this fact-sheet

Definition

Very rare opportunistic fungal infection in immunocompromised patients, of invasive form, with high aggressive potential.

50% mortality risk related to vascular involvement: arteriolar dissection, intraluminal proliferation, aneurysms, and septic emboli.

Airborne contamination: rhinocerebral and pulmonary infections are frequent.

Clinical features

Sinusitis and pneumonia in a context of immunosuppression.
Presentation identical to aspergillus infections.

Extension to adjacent soft tissues, orbit, and intracranially (skull base vessels).

Hematogenous systemic dissemination with possible multivisceral involvement.

CT

Sinuses:

  • Spontaneous hyperdensities and fine intrasinus calcifications
  • Bone erosions
  • Complications: Orbital involvement with infiltration of the intraorbital fat,
  • bone lysis,
  • involvement of skull base vessels with extension to the cavernous sinus (+/- thrombosis) and the intracavernous carotid artery
  • --> Ischemic strokes, mycotic abscesses, and aneurysms.

Lung:

  • Reversed halo sign: ground-glass opacity surrounded by consolidation corresponding to the inflammatory front.
  • Reticulations within the central ground-glass opacity producing a crazy-paving-like pattern, corresponding to ischemic phenomena.

MRI

Sinuses:

  • Sinus opacification with marked T2 hypointensity and intermediate T1 signal.
  • T2 hypointensity related to fungal or manganese deposits (paramagnetic effect produced by bacterial proteins)
  • Complications: Orbital involvement with infiltration of the intraorbital fat,
  • bone lysis,
  • involvement of the vessels at the skull base with extension to the cavernous sinus (+/- thrombosis) and the intracavernous carotid artery
  • --> Ischemic strokes, abscesses, and mycotic aneurysms.

Management

Medical treatment (amphotericin B) and urgent surgical treatment.

Differential diagnosis

Other fungal sinusitis
On MRI:
Intrasinus calcifications (on MRI)
Old thick secretions
Intrasinus hemorrhage

Pneumonia: angioinvasive aspergillosis.