Images in Clinical Medicine
Kim Eagle, M.D., Editor
Rhinocerebral Mucormycosis
N Engl J Med 1995; 333:564August 31, 1995
- Article
Figure 1 A 45-year-old woman with poorly controlled insulin-dependent diabetes mellitus had facial and periorbital swelling for three to four days. On the day of admission she was unable to open her right eye (Panel A). On admission she had a white-cell count of 22,000 per cubic millimeter, with 84 percent neutrophils and bands and a moderate degree of metabolic acidosis (blood pH, 7.22; plasma bicarbonate concentration, 8 mmol per liter). A computed tomographic scan of the head (Panel B) showed involvement of the paranasal sinuses (arrow) and periorbital soft tissues. Material from the periorbital tissue (Panel C), stained with periodic acid-Schiff stain (×560), demonstrated typical irregularly shaped broad hyphae with right-angle branching (arrow). In Panel D, the characteristic sporangia (arrowhead) and rhizoids (arrow) of the pathogen, rhizopus species, are apparent on staining with lactophenol blue (×130).
The patient was treated with amphotericin B (total dose, 2800 mg) for 35 days and surgical debridement, which included enucleation of the right eye and resection of the right paranasal sinuses. The patient is now undergoing reconstructive surgery.
Kim Eagle, M.D.
Mark E. Rupp, M.D.
University of Nebraska Medical Center, Omaha, NE 68198
