[Invasive sinusitis after allogenic stem cell transplantation - Case 4/2010]

Dtsch Med Wochenschr 135(20):1032 (2010) PMID 20461662

HISTORY AND ADMISSION FINDINGS: More than two years after unrelated stem cell transplantation with ongoing immunosuppressive therapy due to chronic graft-versus-host disease a patient was admitted with dyspnea. In the sequel, the patient developed ptosis. DIAGNOSIS: CT scan of paranasal sinus demonstrated an orbita-infiltrating tumor identified as mucormycosis by microbiology and biopsy. Further diagnostics showed cerebral involvement. Due to additional pancytopenia a conservative approach to this rhino-orbito-cerebral mucormycosis was chosen. TREATMENT AND COURSE: With dose intensive liposomal amphotericin B and posaconazol maintenance therapy stabilization followed by continuously regression was achieved. CONCLUSION: Infections with mucorales have a low incidence, though due to rapid progression and high mortality they should be included into diagnostic considerations. Diagnosis is confirmed by biopsy and therapy is primarily operative. Systemic therapy is targeted to eliminate underlying risk factors (cytopenia, immunosuppression, ketoacidosis, iron overload) and application of effective antimycotics as mono- or combined therapy. Georg Thieme Verlag KG Stuttgart * New York.