Rhinoorbital mucormycosis secondary to Rhizopus oryzae: a case report and literature review.

Mucormycosis is a form of fulminant invasive fungal infection of the sinonasal tract that often extends to the orbit, brain, palate, and skin. It is caused by members of the order Mucorales, and it is considered to be the most fatal fungal infection known to man because it is rapidly disseminated by the blood vessels. It is most commonly associated with diabetic ketoacidosis, hematologic malignancies, acquired immunodeficiency syndrome, and immunosuppressive therapy. This rare opportunistic infection exists in many forms, the most common of which is rhinocerebral mucormycosis. Treatment includes aggressive surgical debridement of the necrotic tissue combined with systemic antifungal therapy. In this case report, we describe the successful management of rhinoorbital mucormycosis, a subtype of the rhinocerebral variety, secondary to Rhizopus oryzae that developed in a patient with lymphoma. We review the diagnostic work-up and discuss the literature with respect to the presentation, pathophysiology, management, and outcome of the disease.

Allergic fungal rhinosinusitis: a report of 8 cases.

Eight patients presented with clinical manifestations such as polyps and mucin were reported to have allergic fungal rhinosinusitis (AFS). Histopathologic sections from tissue samples containing mucin from the paranasal sinuses obtained by endoscopic operation showed scattered hyphal elements within the allergic mucin but no tissue invasion. Associated fungi were 4 cases of Aspergillus flavus; a case each of Aspergillus niger and Bipolaris hawaiiensis, mixed colonization with B. hawaiiensis, and Curvularia lunata; and 1 case of Bipolaris species. Elevated immunoglobulin E level was reported in some patients ranging from (706 to 1969 IU/mL). All patients underwent endoscopic surgery; polypectomy and clearance of all affected sinuses were performed. Medical treatment involved the use of local and systemic corticosteroids. The patients have done well, with no evidence of recurrent disease.

Allergic Aspergillus flavus rhinosinusitis: a case report from Qatar.

Fungal involvement in rhinosinusitis is classified into four major forms: allergic, mycetoma, chronic invasive (indolent) and acute invasive (fulminant). It can become life threatening if not diagnosed and treated properly. The preliminary diagnosis is usually made by nasal endoscopy and computed tomography (CT) imaging, but tissue biopsy and culture are of vital importance in confirming the disease and in planning treatment. We present a case of allergic fungal rhinosinusitis (AFS) caused by Aspergillus flavus. The clinical manifestation of the disease was the presence of an extensive left nasal polyp. An allergic workup revealed systemic eosinophilia (11.7%), high serum IgE levels (1,201 IU/ml) and a positive skin test for Aspergillus. CT scan showed a total opacification and expansion of the left nasal cavity and sinuses, with a secondary inflammatory reaction on the right side. There was no bony erosion beyond the sinus walls. The patient was operated on using an endoscopic approach (polypectomy and ethmoidectomy), where an abundant amount of allergic fungal mucin and dark crusts were found filling the sinuses. Fungal hyphae were evident in histopathological sections of the removed mucin. Culture of the debris resulted in the growth of Aspergillus flavus. The patient received a full course of systemic and topical steroids. The serum IgE level had dropped to 353 IU/ml and the peripheral eosinophil count to normal (1.38%) by the 10th postoperative month. Surgical debridement and corticosteroids may keep the disease quiescent for a long time.