Rhino-orbital-cerebral Mucormycosis ( 2 фото )

An 82-year-old man with type 2 diabetes presented to the hospital with a 2-week history of headache and spontaneous bruising around his right eye. Six weeks before presentation, he had been hospitalized for severe coronavirus disease 2019 pneumonia and received treatment with high-dose glucocorticoids. He had continued to receive a tapering dose of glucocorticoids for immune thrombocytopenia in the 4 weeks since hospital discharge. On physical examination, ecchymosis was seen over the upper eyelid (Panel A), and a black eschar was present in the right naris . The patient also had proptosis, ophthalmoplegia, and vision loss in the right eye. Nasal endoscopy showed necrotic-appearing black eschars within the nasal cavity and perforation of the nasal septum (Panel B and video). Owing to concern for mucormycosis, antifungal therapy was initiated. Magnetic resonance imaging of the head showed involvement of the right orbit, the maxillary and ethmoid sinuses on both sides, and the right frontal lobe of the brain (Panel C, asterisk). Histopathological findings in a biopsy specimen from the right maxillary sinus were consistent with invasive mucormycosis. A diagnosis of rhino-orbital-cerebral mucormycosis was made. The patient was transferred to a tertiary care hospital, where extensive surgical débridement was performed. He died in the hospital 10 weeks after presentation.


Cristian-Mihail Niculae, M.D.
Carol Davila University of Medicine and Pharmacy, Bucharest, Romania

Laura Craciun, M.D., Ph.D.
Hospital Colentina, Bucharest, Romania

March 21, 2024
N Engl J Med 2024; 390:e30
DOI: 10.1056/NEJMicm2309352

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