Saudi Journal of Kidney Diseases and Transplantation

LETTER TO EDITOR
Year
: 2006  |  Volume : 17  |  Issue : 1  |  Page : 62--63

Post dialysis Rhino cerebral Mucormycosis


Weal L Jabur, Harith M Aljebory 
 Department of Nephrology, Al Krammah Hospital, Baghdad, Iraq

Correspondence Address:
Weal L Jabur
Department of Nephrology, Al Krammah Hospital, Baghdad
Iraq




How to cite this article:
Jabur WL, Aljebory HM. Post dialysis Rhino cerebral Mucormycosis.Saudi J Kidney Dis Transpl 2006;17:62-63


How to cite this URL:
Jabur WL, Aljebory HM. Post dialysis Rhino cerebral Mucormycosis. Saudi J Kidney Dis Transpl [serial online] 2006 [cited 2021 Sep 19 ];17:62-63
Available from: https://www.sjkdt.org/text.asp?2006/17/1/62/32447


Full Text

To the Editor:

Mucormycosis is a devastating fungal infection, which usually occurs in patients with diabetic ketoacidosis, [1] chronic renal failure, hematological malignancy or solid organ transplant recipients. [2] The four main clinical presentations include rhino cerebral, pulmonary, gastrointestinal or disseminated form.[2] The most common pathogen species are Rhizopus oryzae, Rhizomucar pusillus and Absidia corymbifera.[3] The mortality rate is around 80%. [4]

We would like to share this case with the readers of your journal. A 55-year-old man was started on peritoneal dialysis because of uremic symptoms due to chronic renal failure secondary to obstructive nephropathy.

The disease was diagnosed few months prior to his presentation. The patient did not have history of diabetes or hypertension. The uremic manifestations dramatically improved on dialysis. On the day post the first session of dialysis the patient developed severe headache associated with left eyelid swelling, which progressed over few days to complete ptosis, proptosis, miosis, and ophthalmoplagia with gradual loss of vision [Figure 1],[Figure 2]. A primary diagnosis of cavernous sinus thrombosis was made despite the patient's negative magnetic resonance imaging (MRI) and immediately was treated with broad spectrum antibiotics and anticoagulants. However, the condition did not improve and the swelling extended to involve the left cheek skin, which became dusky red with sharp demarcation line. The follow-up MRI and arteriography and veno­graphy study showed inflamed and destructed maxillary and ethmoidal sinuses [Figure 3],[Figure 4]. His nasal swab confirmed the diagnosis. The patient was diagnosed to have mucor-mycosis and amphotericin B was started. The family refused to do surgical debridement. Eventually, the patient unfortunately died on the 10 th day post admission.

The review of 179 patients with the rhino cerebral mucormycosis showed that 127(70%) were diabetic and ketoacidosis were present in most of the cases.[5],[6] Our patient was not diabetic but had renal failure. Rhino cerebral mucormycosis usually presents as an acute sinusitis with dark nasal redness, fever and painful sinuses with later involvement of the adjacent structures like the orbit and cavernous sinus.[7],[8] In our case, the primary presentation of the infection was orbital with possible cavernous sinus involvement that was not detected by the primary MRI study. This resulted in the delayed diagnosis for a rather aggressive infection and the death of the patient. Computerized scan is not sensitive enough since about 50% of the initial CT scan studies may be negative.[9]

References

1Lehrer RI, Howard DH, Syphered PS, et al. Mucormycosis Review. Ann Intern Med 1980; 1960:93-10
2Benbow EW. Systemic zygomycosis. Postgrad Med J 1986; 62:985-96.
3Sugar AM. Mucormycosis. Clin Infect Dis 1992;14{ suppl 1 }:S126-9.
4Tedder M, Spratt JA, Anstadt MP, Hedge SS, Tedder SD, Lowe JE. Pulmonary mucormycosis: results of medical and surg therapy. Ann Thorac Surgery 1994;57:1044-50.
5Fairley C, Sullivan TJ, Bartley P. Survival after rhino - orbital - cerebral mucormycosis in an immunocompetent patient. Ophthalmology 2000; 107 (3): 555-8.
6McNulty, JS. Rhinocerebral mucor­mycosis: predisposing factors. Laryn­goscope 1982:92-1140-3.
7Camille Kotton, M.D, Infectious Disease Division, Massachusetts General Hospital and Brigham and Women Hospital, Boston, MA. Review provided by Verimed healthcare network.
8Guevara N, Roy D, Dutruc-Rosset C,et al. Mucormycosis - early diagnosis and treat­ment. Rev Laryngol Otol Rhinol (B)2004; 125 (2):127-31.
9Harrison textbook of medicine 2001; mucormycosis.