Rhinocerebral Mucormycosis Differential Diagnoses

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