Diagnostic Considerations

The clinician must retain a high clinical suspicion for mucormycosis in patients at risk. A delay in diagnosis can be fatal.

Rhinocerebral mucormycosis may initially resemble bacterial sinusitis and may mimic malignancy. Antibiotic therapy for sinusitis should be discontinued immediately upon diagnosis of mucormycosis.

Rhinocerebral mucormycosis may be confused with allergic fungal sinusitis, which is caused by phaeohyphomycoses in individuals with histories of allergic rhinitis, elevated immunoglobulin E levels, nasal polyps, and recurrent or chronic sinusitis. Allergic fungal sinusitis slowly progresses over months to years, and although it causes proptosis and a large rhinocerebral mass, it does not invade tissue or meninges.

Aspergillosis can cause a similar disease, with CNS invasion, and carries a poor prognosis. An important difference is that itraconazole may play a role in treatment. Histologic stains can differentiate between the fungi.

Conditions to consider in the differential diagnosis of rhinocerebral mucormycosis include the following:

Migraine headache
Chronic sinusitis
Dental abscess

Causes of eye pain to consider in the differential diagnosis include the following:

Blepharitis
Preseptal cellulitis
Orbital cellulitis

Causes of proptosis to consider in the differential diagnosis include the following:

Orbital tumor
Posttraumatic subperiosteal hematoma
Inflammatory pseudotumor
Cavernous sinus thrombosis

Differential Diagnoses

Workup

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Media Gallery

Clinical view of the face of a patient with rhinocerebral mucormycosis. Notice the cutaneous hemorrhagic ulcer on the right anterior cheek resulting from perforation of the fungus through the sinus cavity.
A cotton blue preparation of Rhizopus species.
A tissue hematoxylin and eosin stain of Rhizopus species.
The appearance of a culture slant of Rhizopus species.
Culture plates of Rhizopus species.
Low-power photomicrograph of a Gomori methenamine silver stain of Rhizopus species.
High-power photomicrograph of a Gomori methenamine silver stain of Rhizopus species.
CT brain scan illustrating the appearance of cavernous sinus thrombosis.
CT brain scan showing the appearance of a cerebral infarct.
CT scan of a patient who is suspected of having mucormycosis shows extensive involvement of the right orbit and adjacent sinuses.
This diabetic patient with mucormycosis presented with complete ophthalmoplegia and proptosis. Note the complete ptosis and periorbital edema on the right side.
Characteristic appearance of mucormycosis under the microscope.

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Author

William P Baugh, MD Assistant Clinical Professor of Dermatology, Western University of Health Sciences; Medical Director, Full Spectrum Dermatology; Consulting Staff, Department of Dermatology, St Jude Medical Center

William P Baugh, MD is a member of the following medical societies: American Academy of Dermatology, American Society for Laser Medicine and Surgery, Christian Medical and Dental Associations

Disclosure: Nothing to disclose.

Coauthor(s)

Cynthia C Lazzaro, DO Physician

Cynthia C Lazzaro, DO is a member of the following medical societies: American Academy of Dermatology, American Osteopathic College of Dermatology

Disclosure: Nothing to disclose.

Michael T Yen, MD Professor and The Sarah Campbell Blaffer Chair in Ophthalmology, Division of Ophthalmic Plastic, Lacrimal, and Orbital Surgery, Cullen Eye Institute, Medical Director, Alkek Eye Center, Co-Director, BCM Aesthetics, Program Director, ASOPRS Fellowship, Baylor College of Medicine

Michael T Yen, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Ophthalmic Plastic and Reconstructive Surgery

Disclosure: Nothing to disclose.

Natalie Ana Baugh California State University, Long Beach

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Pranatharthi Haran Chandrasekar, MBBS, MD Professor, Chief of Infectious Disease, Department of Internal Medicine, Wayne State University School of Medicine

Pranatharthi Haran Chandrasekar, MBBS, MD is a member of the following medical societies: American College of Physicians, American Society for Microbiology, International Immunocompromised Host Society, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Acknowledgements

Kenneth C Earhart, MD Deputy Head, Disease Surveillance Program, United States Naval Medical Research Unit #3

Kenneth C Earhart, MD is a member of the following medical societies: American College of Physicians, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, and Undersea and Hyperbaric Medical Society

Disclosure: Nothing to disclose.

Thomas M Kerkering, MD Chief of Infectious Diseases, Virginia Tech Carilion School of Medicine

Thomas M Kerkering, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American Public Health Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Medical Society of Virginia, and Wilderness Medical Society

Disclosure: Nothing to disclose.

John M Leedom, MD Professor Emeritus of Medicine, Keck School of Medicine of the University of Southern California

John M Leedom, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, American Society for Microbiology, Infectious Diseases Society of America, International AIDS Society, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment