Ficomicose (mucormicose) orbito-rino-cerebral: registro de um caso

Guerreiro, C. A. M.; Nobrega, J. P. S.; Carvalho, Monica P.

doi:10.1590/S0004-282X1980000100013

Resumos

Registro de caso de mucormicose órbito-rino-cerebral em paciente diabético e em cetoacidose, com quadro clínico característico e que apresentou boa evolução graças ao tratamento iniciado precocemente. É feito um resumo dos principais registros da literatura a respeito da patologia.

The case of a 15 years old white man, diabetic in cetoacidosis, with a orbit-rhino-cerebral phycomycosis is reported. The illness had an acute onset and the treatment was iniciated early with Amphotericin-B and unilateral osteotomy of maxillary and ethmoidal sinus. With this treatment the patient did well with residuals of ophtalmoplegia and amaurosis on the right. Interesting investigation aspects are the occluded internal carotid on the same side of the affected orbit and the CAT-SCAN finding of moderated ventricular dilatation (two month after hospital admission). Mycology, pathophysiology, histopathology, clinical aspects, diagnosis and therapy are discussed, comparing the findings of this case with available literature. An increased number of survivors can be expected with earlier recognition and more aggressive therapy. Treatment of the underlying debilitating disease, Amphotericin-B and surgical debridement of necrotic tissue, are frequently necessary such as observed in the case reported. The favorable results ootaineü with the proposed managment are stressed.

Ficomicose (mucormicose) orbito-rino-cerebral: registro de um caso

Orbit-rhino-cerebral phycornycosis: a case report

C. A. M. Guerreiro^I; J. P. S. Nobrega^II; Monica P. Carvalho^III

^IProf. Assistente do Departamento de Neurologia Clínica e Cirurgia da Faculdade de Ciências Médicas da Universidade Estadual de Campinas

^IIMédico Assistente do Departamento de Neurologia do HC da FMUSP

^IIIPatologista do Serviço de Anatomia Patológica do HC da FMUSP

RESUMO

Registro de caso de mucormicose órbito-rino-cerebral em paciente diabético e em cetoacidose, com quadro clínico característico e que apresentou boa evolução graças ao tratamento iniciado precocemente. É feito um resumo dos principais registros da literatura a respeito da patologia.

SUMMARY

The case of a 15 years old white man, diabetic in cetoacidosis, with a orbit-rhino-cerebral phycomycosis is reported. The illness had an acute onset and the treatment was iniciated early with Amphotericin-B and unilateral osteotomy of maxillary and ethmoidal sinus. With this treatment the patient did well with residuals of ophtalmoplegia and amaurosis on the right. Interesting investigation aspects are the occluded internal carotid on the same side of the affected orbit and the CAT-SCAN finding of moderated ventricular dilatation (two month after hospital admission). Mycology, pathophysiology, histopathology, clinical aspects, diagnosis and therapy are discussed, comparing the findings of this case with available literature. An increased number of survivors can be expected with earlier recognition and more aggressive therapy. Treatment of the underlying debilitating disease, Amphotericin-B and surgical debridement of necrotic tissue, are frequently necessary such as observed in the case reported. The favorable results ootaineü with the proposed managment are stressed.

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Trabalho da Divisão de Neurologia do Hospital das Clínicas (HC) da Faculdade de Medicina da Universidade de São Paulo. (FMUSP).

Clinica Neurológica - Faculdade de Medicina, Universidade de São Paulo - Caixa Postal 3461 - 01000 São Paulo, SP - Brasil.

1. ADDLESTONE. R. B. & BAYLIN. G. J. - Rhinocerebral mucormycosis. Radiology 115:113. 1915.
2. BERGER, C. J.: DISQUE. F. C. & TOPAZIAN, R. G. - Rhinocerebral mucormycoses: Diagnosis and treatment. Oral Surg. 40:27, 1975.
3. BLATRIX, C: VERGEZ. A.: GESLIN, P.; DESTOMBES, P.; SEGRETAIN, G.; CHAOUAT, G. & ISRAEL. J. - Mucormycose naso-orbito-cérébrale: a propôs d'une observation typique. Prèsse méd. 78:2113. 1970.
4. EISENBERG. L.: WOOD. T.: BOLES, R. - Mucormycosis. Laryngoscope 87:347, 1977.
5. FRANCO. M. F. & IRIYA. K. - Ficomicose órbito-rino-cerebral associada a cetoacidose diabética. Registro de um caso. Rev. Inst. Med. trop. São Paulo 12:354, 1970.
6. GILBERT, E. F.: KHOURY. G. H. & PORE, R. S. - Histopatological identification of Entomophthora phyccmycosis Arch. Path. 90:583, 1970.
7. GROOTE. C. A. - Rhinocerebral phycomycosis. Arch. Otolaryng. 92:288, 1970.
8. IGNELZI, R. J. & VANDERARK, G. D. - Cerebral mucormycosis following open head trauma. Case report. J. Neurosurg. 42:593. 1975.
9. MEDOFF, G. & KOBAYASHI, G. S. - Pulmonary mucormycosis. New Engl. J. Med. 286:86. 1972.
10. POCH. G. F. FRUGONI. R.; ARA. C.; BREGLIA. M. & PASCUCELLI. H. - Tromboflebitis del seno cavernoso por mucormicosis. Prensa méd. argent. 56:1304. 1969.
11. POLLOCK. R. A.: PRATT, R. C.; SHULMAN, J. A.; & TURNER, J. S. - Nasal mucormycosis: early detection and treatment without radical surgery or Amphotericin-B. Sth. méd. 68:1279, 1975.
12. SANDLER, R.; TALLMAN, C. B.; KEAMY, D. G. & IRVING, W. R. - Successfully treated rhinocerebral phycomycosis in well controlled diabetes. New Engl. J. Med. 285:1180, 1971.
13. RAO, V. R. K.; PILLAI, S. M.; MATHEWS, G.; & RADHAKRISHNAN, V. V. - Cerebral mucormycosis - A case report. Neuroradiology 15:291 (1978).
14. STEPHAN, T.; BUSIS. S. N.; ARENA, S.; KHURANA, R. C. & DANOWSKI, T. S. - Rhino-cerebral Phycomicosis (Mucormycosis). Laryngoscope 83:173, 1973.
15. TABACHNICK, T. T. & LEVINE, B. - Mucormycosis of the craniofacial structures. J. oral Surg. 33:464, 1975.
16. VERGEZ, A.; BLATRIX, P.; POINTUD, P. & SALVANET, A. - Mucormycose orbito-cerebrale (Nouvelle observation). Ann. Oculist. (Paris) 204:285, 1971.
17. WITTIG; E. O.; CAT, I.; ABDALA, H. & KASTING, G. - Meningencefalite a mucormicose: relato de um caso. Arq. Neuro-Psiquiat. (São Paulo) 31:151. 1973.
18. YANAGISAWA, E.; FRIEDMAN, S.; KUNDARGI, R. S.; SMITH. H. W. - Rhinocerebral phycomycosis. Laryngoscope 87:1319, 1977.

Datas de Publicação

Publicação nesta coleção
22 Ago 2012
Data do Fascículo
Mar 1980

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. ADDLESTONE. R. B. & BAYLIN. G. J. - Rhinocerebral mucormycosis. Radiology 115:113. 1915.

[2] 2. BERGER, C. J.: DISQUE. F. C. & TOPAZIAN, R. G. - Rhinocerebral mucormycoses: Diagnosis and treatment. Oral Surg. 40:27, 1975.

[3] 3. BLATRIX, C: VERGEZ. A.: GESLIN, P.; DESTOMBES, P.; SEGRETAIN, G.; CHAOUAT, G. & ISRAEL. J. - Mucormycose naso-orbito-cérébrale: a propôs d'une observation typique. Prèsse méd. 78:2113. 1970.

[4] 4. EISENBERG. L.: WOOD. T.: BOLES, R. - Mucormycosis. Laryngoscope 87:347, 1977.

[5] 5. FRANCO. M. F. & IRIYA. K. - Ficomicose órbito-rino-cerebral associada a cetoacidose diabética. Registro de um caso. Rev. Inst. Med. trop. São Paulo 12:354, 1970.

[6] 6. GILBERT, E. F.: KHOURY. G. H. & PORE, R. S. - Histopatological identification of Entomophthora phyccmycosis Arch. Path. 90:583, 1970.

[7] 7. GROOTE. C. A. - Rhinocerebral phycomycosis. Arch. Otolaryng. 92:288, 1970.

[8] 8. IGNELZI, R. J. & VANDERARK, G. D. - Cerebral mucormycosis following open head trauma. Case report. J. Neurosurg. 42:593. 1975.

[9] 9. MEDOFF, G. & KOBAYASHI, G. S. - Pulmonary mucormycosis. New Engl. J. Med. 286:86. 1972.

[10] 10. POCH. G. F. FRUGONI. R.; ARA. C.; BREGLIA. M. & PASCUCELLI. H. - Tromboflebitis del seno cavernoso por mucormicosis. Prensa méd. argent. 56:1304. 1969.

[11] 11. POLLOCK. R. A.: PRATT, R. C.; SHULMAN, J. A.; & TURNER, J. S. - Nasal mucormycosis: early detection and treatment without radical surgery or Amphotericin-B. Sth. méd. 68:1279, 1975.

[12] 12. SANDLER, R.; TALLMAN, C. B.; KEAMY, D. G. & IRVING, W. R. - Successfully treated rhinocerebral phycomycosis in well controlled diabetes. New Engl. J. Med. 285:1180, 1971.

[13] 13. RAO, V. R. K.; PILLAI, S. M.; MATHEWS, G.; & RADHAKRISHNAN, V. V. - Cerebral mucormycosis - A case report. Neuroradiology 15:291 (1978).

[14] 14. STEPHAN, T.; BUSIS. S. N.; ARENA, S.; KHURANA, R. C. & DANOWSKI, T. S. - Rhino-cerebral Phycomicosis (Mucormycosis). Laryngoscope 83:173, 1973.

[15] 15. TABACHNICK, T. T. & LEVINE, B. - Mucormycosis of the craniofacial structures. J. oral Surg. 33:464, 1975.

[16] 16. VERGEZ, A.; BLATRIX, P.; POINTUD, P. & SALVANET, A. - Mucormycose orbito-cerebrale (Nouvelle observation). Ann. Oculist. (Paris) 204:285, 1971.

[17] 17. WITTIG; E. O.; CAT, I.; ABDALA, H. & KASTING, G. - Meningencefalite a mucormicose: relato de um caso. Arq. Neuro-Psiquiat. (São Paulo) 31:151. 1973.

[18] 18. YANAGISAWA, E.; FRIEDMAN, S.; KUNDARGI, R. S.; SMITH. H. W. - Rhinocerebral phycomycosis. Laryngoscope 87:1319, 1977.