Case of the Week
Section Editors: Matylda Machnowska1 and Anvita Pauranik2
1University of Toronto, Toronto, Ontario, Canada
2BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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November 4, 2013
Nasal Mucormycosis with Invasion of Skull Base
- Acute, fulminant, and lethal opportunistic infection of paranasal sinuses.
- Risk factors include diabetes and immunosuppression.
- Clinical Symptoms: Facial pain, dark turbinates, mental status change, and, depending on the extent of associated exophthalmos, cranial nerve palsy
- Key Diagnostic Features: Non-enhancing turbinates (black turbinate sign); associated sinusitis; extension of inflammatory change into the adjacent skull base, orbit, intracranial compartment, and infratemporal fossa. If there is associated infarction of the mucosa, then associated bright signal along the sinus walls can be seen on DWI. Fungal elements may themselves cause low signal on T2WI.
- DDx: Nasopharyngeal carcinoma, lymphoma, metastasis
- Rx: Early diagnosis and treatment is essential. Otherwise, the prognosis can be dismal. Surgical excision and antifungal Rx is the mainstay.
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