Rhinocerebral Mucormycosis Clinical Presentation

Updated: Apr 03, 2015
  • Author: Michael T Yen, MD; Chief Editor: Mark R Wallace, MD, FACP, FIDSA  more...
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Presentation

History

Symptoms of rhinocerebral mucormycosis are often nonspecific, complicating early diagnosis. The most common presentation includes facial pain, headache, lethargy, visual loss, proptosis, and/or palatal ulcer. Perinasal cellulitis and paresthesia are also common early clinical signs of rhinocerebral mucormycosis. The incubation period is measured in days. The clinical course can progress from normal to symptomatic in a week and from sinus opacification to uncal herniation and death in just a few days. [19, 20, 21, 22]

General symptoms of rhinocerebral mucormycosis include the following:

  • Headache
  • Nausea
  • Fever
  • Lethargy

Facial symptoms of the disease include the following:

  • Weakness
  • Numbness
  • Pain

Nasal symptoms of rhinocerebral mucormycosis include:

  • Purulent drainage
  • Stuffiness and rhinorrhea
  • Epistaxis
  • Nasal hypoesthesia

Ocular symptoms include the following:

  • Periorbital or retro-orbital pain
  • Diplopia and blurred vision
  • Amaurosis (unilateral or bilateral)
  • Possible rapid progress to blindness

CNS symptoms include the following:

  • Convulsions
  • Altered mental status
  • Dizziness
  • Unsteady gait
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Physical Examination

Many individuals with rhinocerebral mucormycosis have underlying diabetes mellitus, usually with acidosis and poor glycemic control. Patients with diabetic ketoacidosis accompanied by mental status changes should improve within 24-48 hours of treatment; if they do not, consider CNS pathology.

Nasal and palatal findings of rhinocerebral mucormycosis include the following:

  • Gray or erythematous appearance
  • Can progress to black necrotic masses (ie, black eschar)
  • Inflammation

Ocular findings include the following:

  • Orbital invasion
  • Orbital cellulitis
  • Conjunctival chemosis
  • Proptosis and periorbital edema
  • Ophthalmoplegia
  • Fixed pupil
  • Orbital apex syndrome [23]
  • Blindness
  • Nystagmus
  • Visual loss secondary to retinal artery thrombosis or direct fungal invasion

Neurologic findings include the following:

  • Palsies of cranial nerves II, III, IV, V, VI, and VII - Commonly observed, prompting a thorough neurologic workup.
  • Cerebral edema and vascular compromise - May lead to coma and stroke
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