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- Title
Rhinocerebral phycomycosis.
- Authors
Yanagisawa, Eiji; Friedman, Stanley; Kundargi, Ronald S.; Smith, Howard W.
- Abstract
Rhinocerebral phycomycosis is an uncommon but important pathologie entity with a rapidly fatal course if treatment is delayed. Successful therapy demands early diagnosis and institution of adequate treatment if complications are to be avoided. Two cases of rhinocerebral phycomycosis which demonstrate the rapidly progressive and devastating nature of this disease are presented. The first case is that of a rapidly progressive rhinocerebral phycomycosis with the classical syndrome of diabetic acidosis, unilateral blindness, ophthalmoplegia and proptosis. Early diagnosis, immediate surgical de-bridement and Amphotericin B therapy resulted in a long-term (five years) survival. This case is also unique in that a large fungal mass was found within the sphenoid sinus, which was removed via sphenoidotomy. If the sphenoid sinus had not been opened and the mass not removed at surgery, this could have been the source of continued infection in spite of Amphotericin B treatment. If preoperative X-rays show cloudiness of the sphenoid sinus, sphenoidotomy is recommended. The second case illustrates a fatal course of rhinocerebral phycomycosis in which surgical treatment was refused. This leukemie patient died within one week from the onset of the disease. Autopsy showed extensive fungal involvement of the posterior orbital contents, ethmoid sinuses, leptome-ninges and cerebrum with thrombosis of the right internal carotid artery and meningoencephalitis. Histological sections showed nonseptate hyphae in the wall and lumen of vessels, occular muscles, optic nerve sheath, leptomeninges, and cerebrum. No leukemie infiltrates were observed in either the brain or orbit. Clinicopathological features of phycomycosis are discussed and the need for early diagnosis is stressed. The most frequent manifestations of rhinocerebral phycomycosis are: 1. diabetic ketoacidosis; 2. blepharoptosis; 3. ophthalmoplegia; i. 'black' turbinate (may appear 'pale' when seen early); 5. X-ray evidence of cloudiness of the involved sinuses without fluid level; and 6. signs of cerebrovascular thrombosis (CVA) with meningoencephalitis. Treatment consists of: 1. control of systemic disease; 2. debridement of involved tissues; and 3. Amphotericin B.
- Publication
Laryngoscope, 1977, Vol 87, Issue 8, p1319
- ISSN
0023-852X
- Publication type
Article
- DOI
10.1288/00005537-197708000-00012