A successful treatment of rhinocerebral mucormycosis due to Rhizopus oryzae
A 65-year-old man with diabetes mellitus type 2 typically had headache (especially in parietal and frontal lobes), nose and the left eye discharge, was admitted in 2012 in Al-Zahara hospital in Isfahan, Iran. He had a fifteen-year's history of diabetes, hypertension, hyperlipoproteinemia, and kidneys dysfunction. He suffered from nightly headache even was not healed with opioid drugs such as morphine and methadone. Each episode of headache has been survived about four hours accompanied by nose and eye discharge. There was no fever, nausea, vomiting, dizziness, diplopia, blurred vision, and memory dysfunction. Proptosis of the left orbit occurred. Brain MRI found the left ethmoidal and maxillary sinusitis and subperiosteal abscess in left orbit. There was a signal change in the left frontal lobe as high signal intensity on T2 FLAIR with edema and minimal mass effect []. Endoscopy of the nose and paranasal sinuses was performed and sampling from tissue and discharges was done and then transferred to the clinical laboratory. Both culture results and the characteristic hyphae in sections [] confirmed mucormycosis. The isolate was identified as Rhizopus oryzae by sequence analysis (Gene Bank accession number is KF228585). The patient was transferred to the Department of Otolaryngology (ENT) and amphotericin B (50 mg/day) was prescribed for him, and debridement of sphenoid sinus walls was performed. Because of renal failure of the patient, drug regimen changed to posaconazole (PCZ)(5 mg/kg). After 20 days, headache recommenced and brain MRI showed invasion to the frontal lobe. He was nominated for craniotomy surgery and finally enucleation of the left eye was accomplished. At last, after revision of paranasal sinuses for assurance of eradication of the disease, the patient was released from hospital with drug regimen of posaconazole (5 mg/kg) for two weeks. We followed up him for one year and he is still alive.