An autopsy case of rhino-orbito-cerebral mucormycosis associated with multiple cranial nerve palsy and subsequent subarachnoid hemorrhage

Hitoshi Kikuchi, Yoshimasa Kinoshita, Kazuhiko Arima, Katsumi Doura, Yoshio Hisatomi, Toshihiko Hashimoto, Hironori Sakai, Hajime Nawata, Toru Iwaki

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6 Citations (Scopus)

Abstract

We report an autopsy case of 53-year-old male with poor controlled diabetes mellitus and hepatocellular carcinoma who developed rhino-orbito- cerebral mucormycosis. Initial complaints were epistaxis and headache followed by a sudden blindness, the 2nd through 7th cranial nerve palsy and diabetes insipidus. Laboratory data revealed that he had liver cirrhosis due to hepatitis C virus infection and diabetes mellitus. Head CT and MRI showed no significant findings. Eleven days after the onset, he died of subarachnoid hemorrhage. The postmortem examination revealed severe infiltration of numerous mucors in the sphenoid sinus, cavernous sinus and bilateral internal carotid arteries. Severe granulomatous vasculitis was seen in the cavernous portion of the bilateral internal carotid arteries. Thus, we considered that this case had been caused by the infiltration of mucors to the cavernous sinus, resulting in the obstruction of ophthalmic arteries. Rupture of the right internal carotid artery was seen at the branching portion of the ophthalmic artery, demonstrating the cause of his death. We would like to emphasize that rhino-orbito-cerebral mucormycosis should be ruled out if we examine a nondiagnostic case of diabetes mellitus or immunosuppressed disease associated with rapid multiple cranial nerve palsy following the orbital symptoms.

Original languageEnglish
Pages (from-to)252-255
Number of pages4
JournalClinical Neurology
Volume38
Issue number3
Publication statusPublished - 1998 Mar 1
Externally publishedYes

Keywords

  • Cavernous sinus
  • Mucormycosis
  • Multiple cranial nerve palsy
  • Subarachnoid hemorrhage

ASJC Scopus subject areas

  • Clinical Neurology

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  • Cite this

    Kikuchi, H., Kinoshita, Y., Arima, K., Doura, K., Hisatomi, Y., Hashimoto, T., Sakai, H., Nawata, H., & Iwaki, T. (1998). An autopsy case of rhino-orbito-cerebral mucormycosis associated with multiple cranial nerve palsy and subsequent subarachnoid hemorrhage. Clinical Neurology, 38(3), 252-255.