Carotid artery occlusion due to fulminant rhinocerebral mucormycosis

Abstract

Mucormycosis is a rare disorder with a potentially lethal course caused by an opportunistic fungus of the Phycomycetes family. Rhinocerebral mucormycosis (RCM) is an acute fulminant form of invasive fungal sinusitis occurring principally in individuals who are immunologically or metabolically compromised. This form originates from one of the paranasal sinuses and may spread to the orbit or the intracranial space either by direct extension or using the unique capability of spreading along vascular walls, leaving the bony structure intact. Carotid artery occlusion is a complication of RCM. Because of the rapidity with which this disease progresses, prompt and aggressive therapy is essential. The morbidity and mortality of this disease are directly related to the length of time before diagnosis and treatment. The diagnosis is difficult because invasive mucormycosis may be present with no mucosal changes and a normal sinus CT scan. It is a histological diagnosis. Treatment of RCM includes early diagnosis, correction of underlying conditions, early and radical surgical debridement, and lipid formulation of amphotericin B. Multiple surgeries are often necessary for adequate debridement. We report a case of carotid artery occlusion due to RCM and discuss the literature on its early signs and symptoms, pathophysiology, and treatment options.