Skip to main content Accessibility help

Rhinocerebral mucormycosis: experience in 14 patients

  • İ Ketenci (a1), Y Ünlü (a1), H Kaya (a1), M A Somdaş (a1), O Kontaş (a2), M Öztürk (a3) and A Vural (a1)...



Mucormycosis is an opportunist, often lethal fungal infection which occurs in immunocompromised patients. We present our experience in 14 patients with this condition.

Patients and methods:

A retrospective chart review was conducted for 14 patients treated for rhinocerebral mucormycosis.


Nine patients had diabetes mellitus and six had a haematological malignancy. Nine patients had cutaneous and/or palatal necrosis. Eleven patients were treated with amphotericin B and five with liposomal amphotericin B. Endoscopic sinus surgery was performed in five patients with disease limited to the sinonasal cavity; nine patients underwent more extensive surgery. Five patients with disease limited to the sinonasal cavity survived, while nine patients with widely disseminated disease died. Five of the nine diabetic patients died, as did five of the six patients with haematological malignancy.


Patients with rhinocerebral mucormycosis spreading outside the sinonasal cavity have a poor prognosis.


Corresponding author

Address for correspondence: Dr İbrahim Ketenci, Alpaslan Mah Bahar Cad, Şişli Sitesi A Blok 20/26, 38040 Kayseri, Turkey Fax: +90 352 4379164 E-mail:


Hide All
1Ribes, JA, Vanover-Sams, CL, Baker, DJ. Zygomycetes in human disease. Clin Microbiol Rev 2000;13:236301
2Yohai, RA, Bullock, JD, Aziz, AA, Markert, RJ. Survival factors in rhino-orbital-cerebral mucormycosis. Surv Ophthalmol 1994;39:322
3Mohindra, S, Gupta, R, Bakshi, J, Gupta, SK. Rhinocerebral mucormycosis: the disease spectrum in 27 patients. Mycoses 2007;50:290–6
4Sundaram, C, Mahadevan, A, Laxmi, V, Yasha, TC, Santosh, V, Murthy, JM et al. Cerebral zygomycosis. Mycoses 2005;48:396407
5Yeung, CK, Cheng, VC, Lie, AK, Yuen, KY. Invasive disease due to mucorales: a case report and review of the literature. Hong Kong Med J 2001;7:180–8
6Luna, JD, Ponssa, XS, Rodriguez, SD, Luna, NC, Juarez, CP. Intraconal amphotericin B for the treatment of rhino-orbital mucormycosis. Ophthalmic Surg Lasers 1996;27:706–8
7Blitzer, A, Lawson, W, Meyers, BR, Biller, HF. Patient survival factors in paranasal sinus mucormycosis. Laryngoscope 1980;90:635–48
8Peterson, KL, Wang, M, Canalis, RF, Abemayor, E. Rhinocerebral mucormycosis: evolution of the disease and treatment options. Laryngoscope 1997;107:855–62
9Sims, CR, Zeichner, LO. Contemporary treatment and outcomes of zygomycosis in a non-oncologic tertiary care center. Arch Med Res 2007;38:90–3
10Gillespie, MB, O'Malley, BW, Francis, HW. An approach to fulminant invasive fungal rhinosinusitis in the immunocompromised host. Arch Otolaryngol Head Neck Surg 1998;124:520–6
11Hargrove, RN, Wesley, RE, Klippenstein, KA, Fleming, JC, Haik, BG. Indications for orbital exenteration in mucormycosis. Ophthal Plast Reconstr Surg 2006;22:286–91
12Turunc, T, Demiroglu, YZ, Aliskan, H, Colakoglu, S, Arslan, H. Eleven cases of mucormycosis with atypical clinical manifestations in diabetic patients. Diabetes Res Clin Pract 2008;82:203–8
13Kennedy, CA, Adams, GL, Neglia, JP, Giebink, GS. Impact of surgical treatment on paranasal fungal infections in bone marrow transplant patients. Otolaryngol Head Neck Surg 1997;116:610–16
14Pillsbury, HC, Fischer, ND. Rhinocerebral mucormycosis. Arch Otolaryngol 1977;103:600–4
15Bodenstein, NP, McIntosh, WA, Vlantis, AC, Urquhart, AC. Clinical signs of orbital ischemia in rhino-orbitocerebral mucormycosis. Laryngoscope 1993;103:1357–61
16Talmi, YP, Goldschmied-Reouven, A, Bakon, M, Barshack, I, Wolf, M, Horowitz, Z et al. Rhino-orbital and rhino-orbito-cerebral mucormycosis. Otolaryngol Head Neck Surg 2002;127:2231
17Gillespie, MB, O'Malley, BW. An algorithmic approach to the diagnosis and management of invasive fungal rhinosinusitis in the immunocompromised patient. Otolaryngol Clin North Am 2000;33:323–34
18Gravesen, S. Fungi as a cause of allergic disease. Allergy 1979;34:135–54
19Alleyne, CH, Vishteh, AG, Spetzler, RF, Detwiler, PW. Long term survival of a patient with invasive cranial base rhinocerebral mucormycosis treated with combined endovascular, surgical, and medical therapies: case report. Neurosurgery 1999;45:1461–4
20Ferguson, BJ. Mucormycosis of the nose and paranasal sinuses. Otolaryngol Clin North Am 2000;33:349–65
21Jung, SH, Kim, SW, Park, CS, Song, CE, Cho, JH, Lee, JH et al. Rhinocerebral mucormycosis: consideration of prognostic factors and treatment modality. Auris Nasus Larynx 2009;36:274–9
22Spellberg, B, Edwards, J, Ibrahim, A. Novel perspectives on mucormycosis: pathophysiology, presentation, and management. Clin Microbiol Rev 2005;18:556–69
23Centeno, RS, Bentson, JR, Mancuso, AA. CT scanning in rhinocerebral mucormycosis and aspergillosis. Radiology 1981;140:383–9
24Terk, MR, Underwood, DJ, Zee, CS, Colletti, PM. MR imaging in rhinocerebral and intracranial mucormycosis with CT and pathologic correlation. Magn Reson Imaging 1992;10:81–7
25Weir, NW, Golding-Wood, DG. Infective rhinitis and sinusitis. In: Kerr, GA, MacKay, IS, Bull, TR, eds. Scott-Brown's Otolaryngology, 6th edn.Oxford: Butterworth-Heinemann, 1997;4/8/14
26Avet, PP, Kline, LB, Sillers, MJ. Endoscopic sinus surgery in the management of mucormycosis. J Neuroophthalmol 1999;19:5661
27Roden, MM, Zaoutis, TE, Buchanan, WL, Knudsen, TA, Sarkisova, TA, Schaufele, RL et al. Epidemiology and outcome of zygomycosis: a review of 929 reported cases. Clin Infect Dis 2005;41:634–53
28Zaoutis, TE, Roilides, E, Chiou, CC, Buchanan, WL, Knudsen, TA, Sarkisova, TA et al. Zygomycosis in children: a systematic review and analysis of reported cases. Pediatr Infect Dis J 2007;26:723–7
29Pagano, L, Ricci, P, Tonso, A, Nosari, A, Cudillo, L, Montillo, M et al. Mucormycosis in patients with haematological malignancies: a retrospective clinical study of 37 cases. GIMEMA infection program (Gruppo Italiano Malattie Ematologiche Maligne dell'Adulto). Br J Haematol 1997;99:331–6
30Eucker, J, Sezer, O, Graf, B, Possinger, K. Mucormycoses. Mycoses 2001;44:253–60
31Greenberg, RN, Scott, LJ, Vaughn, HH, Ribes, JA. Zygomycosis (mucormycosis): emerging clinical importance and new treatments. Curr Opin Infect Dis 2004;17:517–25
32Kontoyiannis, DP, Lewis, RE. Invasive zygomycosis: update on pathogenesis, clinical manifestations, and management. Infect Dis Clin North Am 2006;20:581607
33Rosenberg, SW, Lepley, JB. Mucormycosis in leukemia. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1982;54:2632
34Bullock, JD, Jampol, LM, Fezza, AJ. Two cases of orbital phycomycosis with recovery. Am J Ophthalmol 1974;78:811–15
35Hejny, C, Kerrison, JB, Newman, NJ, Stone, CM. Rhino-orbital mucormycosis in a patient with acquired immunodeficiency syndrome (AIDS) and neutropenia. Am J Ophthalmol 2001;132:111–12
36Lueg, EA, Ballagh, RH, Forte, V. Analysis of the recent cluster of invasive fungal sinusitis at the Toronto Hospital for Sick Children. J Otolaryngol 1996;25:366–70
37Sahin, B, Paydas, S, Cosar, E, Bicakci, K, Hazar, B. Role of granulocyte colony-stimulating factor in the treatment of mucormycosis. Eur J Clin Microbiol Infect Dis 1996;15:866–9
38Bonifaz, A, Macias, B, Paredes-Farrera, F, Arias, P, Ponce, RM, Araiza, J. Palatal zygomycosis: experience of 21 cases. Oral Dis 2008;14:569–74
39Scheckenbach, K, Cornely, O, Hoffmann, TK, Engers, R, Bier, H, Chaker, A et al. Emerging therapeutic options in fulminant invasive rhinocerebral mucormycosis. Auris Nasus Larynx 2010;37:322–8
40John, BV, Chamilos, G, Kontoyiannis, DP. Hyperbaric oxygen as an adjunctive treatment for zygomycosis. Clin Microbiol Infect 2005;11:515–17
41Simmons, JH, Zeitler, PS, Fenton, LZ, Abzug, MJ, Fiallo-Scharer, RV, Klingensmith, GJ. Rhinocerebral mucormycosis complicated by internal carotid artery thrombosis in a pediatric patient with type 1 diabetes mellitus: a case report and review of the literature. Pediatr Diabetes 2005;6:234–8
42Tarani, L, Costantino, F, Notheis, G, Wintergerst, U, Venditti, M, Di Biasi, C et al. Long-term posaconazole treatment and follow-up of rhino-orbital-cerebral mucormycosis in a diabetic girl. Pediatr Diabetes 2009;10:289–93
43Kohn, R, Hepler, R. Management of limited rhino-orbital mucormycosis without exenteration. Ophtalmology 1985;92:1440–4
44Fingeroth, JD, Roth, RS, Talcott, JA, Rinaldi, MG. Zygomycosis due to Mucor circinelloides in a neutropenic patient receiving chemotherapy for acute myelogenous leukemia. Clin Infect Dis 1994;19:135–7
45Anaissie, EJ, Shikhani, AH. Rhinocerebral mucormycosis with internal carotid occlusion: report of two cases and review of the literature. Laryngoscope 1985;95:1107–13



Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed