Clinical Manifestations

Initial clinical manifestations of rhinocerebral mucormycosis mimic those of acute bacterial sinusitis. Therefore, the clinician needs a high index of suspicion when evaluating

FIGURE 2 1.5 Tesla multiplanar MR with axial T1-weighted postgadolinium imaging in a patient with biopsy-proven mucormycosis. There is near complete opacifica-tion of ethmoid sinuses. Ill-defined peripheral enhancement extends into the right medial rectus and left orbital apex. Abnormal signal surrounds both carotid arteries within their course through the cavernous sinus. Abbreviation: MR, magnetic resonance.

FIGURE 2 1.5 Tesla multiplanar MR with axial T1-weighted postgadolinium imaging in a patient with biopsy-proven mucormycosis. There is near complete opacifica-tion of ethmoid sinuses. Ill-defined peripheral enhancement extends into the right medial rectus and left orbital apex. Abnormal signal surrounds both carotid arteries within their course through the cavernous sinus. Abbreviation: MR, magnetic resonance.

an immunosuppressed patient. Fever, headache, and cough may be the only symptoms. The presence of epistaxis, sinonasal ulceration or eschar, palatal eschar, proptosis, decreased vision, or facial swelling is alarming and suggestive of invasive disease (21). Rapid disease progression follows. Patients may initially report facial pain that progresses to facial anesthesia as trigeminal nerve invasion occurs. Once infection reaches the frontal lobes, mental status changes and obtundation ensues. Spread from the sphenoid sinus to the adjacent cavernous sinus is heralded by cranial nerve palsy or visual loss.

Mucormycosis is not limited to the head and neck region. Pulmonary mucormycosis is rapidly progressive and often fatal. Patients present with fever and hemoptysis. Transmission is by inhalation of spores with subsequent development of a necrotizing pneumonia that can spread to the mediastinum and heart. Gastrointestinal, cutaneous, and renal involvement have also been reported.

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