OBJECTIVE: Sinonasal mucormycosis is a rare fulminant disorder that typically affects immunocompromised patients. This article focuses primarily on the clinical manifestations and the importance of early diagnosis and treatment of this disease. PATIENTS AND METHODS: Four pediatric cases of sinonasal mucormycosis encountered over an 8-year-period in our institution are reported. The initial presenting symptoms, physical examination, computed tomography, intraoperative, and histopathologic findings are described. The underlying immunosuppressive diseases are also outlined. RESULTS: The most common signs and symptoms were fever, rhinorrhea, facial erythema and edema, and very pale nasal mucosa. Despite these manifestations, the diagnosis of sinonasal mucormycosis was delayed, except in one child. Computed tomography scan findings were nonspecific and did not correlate well with surgical and pathologic findings. Treatment consisted in a combination of antifungal agents, multiple aggressive surgical debridements, and control of the underlying disease. In the postoperative course, 1 child died of the disease, 1 developed a persistent unilateral blindness, 1 was lost to follow-up, and the last 1 was cured with no sequelae. CONCLUSIONS: Sinonasal mucormycosis in the immunocompromised pediatric population is an uncommon but potentially fatal disease. A high index of suspicion is of utmost importance to decrease its related morbidity and mortality.
OBJECTIVE:Sinonasal mucormycosis is a rare fulminant disorder that typically affects immunocompromised patients. This article focuses primarily on the clinical manifestations and the importance of early diagnosis and treatment of this disease. PATIENTS AND METHODS: Four pediatric cases of sinonasal mucormycosis encountered over an 8-year-period in our institution are reported. The initial presenting symptoms, physical examination, computed tomography, intraoperative, and histopathologic findings are described. The underlying immunosuppressive diseases are also outlined. RESULTS: The most common signs and symptoms were fever, rhinorrhea, facial erythema and edema, and very pale nasal mucosa. Despite these manifestations, the diagnosis of sinonasal mucormycosis was delayed, except in one child. Computed tomography scan findings were nonspecific and did not correlate well with surgical and pathologic findings. Treatment consisted in a combination of antifungal agents, multiple aggressive surgical debridements, and control of the underlying disease. In the postoperative course, 1 child died of the disease, 1 developed a persistent unilateral blindness, 1 was lost to follow-up, and the last 1 was cured with no sequelae. CONCLUSIONS:Sinonasal mucormycosis in the immunocompromised pediatric population is an uncommon but potentially fatal disease. A high index of suspicion is of utmost importance to decrease its related morbidity and mortality.
Authors: Shannon M Cohn; Hanumantha R Pokala; Jane D Siegel; John E McClay; David Leonard; Jeannie Kwon; Charles F Timmons; Naomi J Winick Journal: Support Care Cancer Date: 2016-08-12 Impact factor: 3.603