Inwazyjna grzybica zatok przynosowych powikłana ropniem mózgu – opis przypadku

Mucormycosis is a rare disease caused by fungi of the genus Mucorales . It is most common in patients with inadequately controlled diabetes mellitus, in transplant recipients or in patients with cancer. A 41-year-old patient was referred to the ENT Department of Medical University of Warsaw with a diagnosis of sinusitis and blindness of the left eye. In an interview swelling tissue of the left orbital cavity, ptosis and loss of vision in the left eye was reported. Clinical CT and MRI revealed swelling of the left half of the face and left orbital fat tissue, massive mucosal thickening in the maxillary sinus and the sphenoid sinus on the left side, encephalitis of the left frontal lobe base, poor contrast enhancement in left cavernous sinus, and hard palate ulceration on the left side. After histopathological confirmation of fungal infection of the paranasal sinuses, the patient underwent endoscopic sphenoethmoidectomy with opening of the left orbit, limited maxillectomy. The patient was treated conservatively with liposomal form of amphotericin B. Two weeks after surgery, MRI revealed an abscess of the left frontal lobe base and the base of the skull. Sinus surgery with skull base and hard palate reconstruction and also left-sided enucleation was performed. Conservative treatment was continued which resulted in an improvement. Surgery is an independent factor for improving survival in patients with invasive fungal rhinosinusitis. Important factors for the patients’ survival are spread of the disease to the central nervous system and diabetes, which can cause a double increase in mortality.