Republication de : Reducing mortality in mucormycosis of the head and neck in diabeticpatients: A CARE case series - 18/05/22

Doi : 10.1016/j.aforl.2022.03.002

D. Kaushal ^a,⁎ , N. Rajan ^b, K. Soni ^b, A. Sharma ^c, B. Choudhury ^b, T. Yadav ^d, P. Khera ^d, P. Gupta ^b, N. Kaur ^c, A. Goyal ^b
^a Department of Otorhinolaryngology, All India Institute of Medical Sciences, 174001 Bilaspur, India
^b Department of Otorhinolaryngology, All India Institute of Medical Sciences, 342005 Jodhpur, India
^c Department of Microbiology, All India Institute of Medical Sciences, 342005 Jodhpur, India
^d Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, 342005 Jodhpur, India

^*Corresponding author.

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Abstract

Introduction

Rhinocerebral mucormycosis is extremely fatal, with mortality rates ranging from 85-93% despite the best treatment in immunocompromised patients. We emphasize the importance of early diagnosis, repeated debridement, and aggressive antifungal treatment to reduce mortality.

Case summary

We report six cases (five male and one female), with a mean age of 51 years who were diagnosed to have mucormycosis from 2017 to 2019. All patients were diabetic. Intracranial involvement and orbital involvement were found in four cases. Facial nerve palsy was seen in two cases, one without any apparent otological involvement. Aggressive serial debridement and amphotericin B was started. Posaconazole was added subsequently to the treatment in two cases. One patient succumbed to the disease five months after discharge. The other five patients are on regular follow-up for a mean duration of 14 months at the end of which two had residual disease which was under control.

Discussion

Repeated surgical debridement with an early aggressive and combination antifungal therapy can result in good outcomes even in advanced mucormycosis. Concurrent management of the underlying pathology, monitoring of liver and kidney functions, and therapeutic drug monitoring are useful to ensure smooth and effective treatment.

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Keywords : Rhinocerebral Mucormycosis, Amphotericin B, Combination antifungal agents, Debridement, Case series

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Cet article a fait l’objet d’une première publication dans les European Annals of Otorhinolaryngology, Head and Neck Diseases. Nous le republions ici dans les pages des Annales Françaises d’Otolaryngologie, son titre jumelé. Avec autorisation de l’éditeur. Pour la citation veuillez utiliser la référence de la première parution : European Annals of Otorhinolaryngology, Head and Neck Diseases, 139 (3) (2022) 146–152. https://doi.org/10.1016/j.anorl.2021.06.015.