POSTTRAUMATIC CRANIAL MUCORMYCOSIS IN AN IMMUNOCOMPETENT PATIENT

Mucormycosis almost exclusively affects immunocompromised patients or diabetics with metabolic complications,(1,2) but there have been case reports of mucormycosis in healthy individuals.(3-9) Therapy should include control of the underlying condition, excision of the affected tissue, and high doses of amphotericin B.(10) Although the prognosis of this disease has traditionally been considered ominous, early diagnosis and the use of aggressive surgery have increased survival rates to close to 70%.(11) Though the majority of cases have involved acute syndromes, there have been reports of chronic mucormycosis presenting as osteomyelitis months or years after the initial episode(12-16) that required surgical treatment to control the disease. Amphotericin B desoxicholate (AmB) is a toxic drug, When used in high doses, as is usually the case in treatment of mucormycosis, toxicity is the rule. Liposomal amphotericin B (L-AmB) allows administration of high doses of amphotericin B without increasing its toxicity.(17) Despite the existence of good results with some deep infections,(18,19) experience with L-AmB in mucormycosis is anecdotal,(20-22) We describe a case of chronic osteomyelitis after bilateral rhino-orbital mucormycosis of posttraumatic origin in an immunocompetent patient. Conventional therapy with aggressive surgery and administration of systemic AmB in high doses did not control the illness. Complete surgery was impossible due to the extent of the area affected, with destruction of the frontal diploe, development of bone sequestra, necrosis of the orbital rim, and involvement of the masticatory spaces. L-AmB as the only alternative treatment controlled the disease. Tolerance of the drug was excellent despite the patient receiving an accumulated dose of 19 g of amphotericin B (4 g of AmB and 15 g of L-AmB).