Our experience in endoscopic management of mucormycosis: a case series and review of literature

Sinonasal mucormycosis is uncommon entity and it rarely infects a healthy host. When it does occur; it becomes very difficult to treat because of the speed of progress of disease and can have fatal outcomes. The mainstays of therapy are treatment of immunocompromised status, systemic high dose Amphotericin B, and surgical debridement of necrosed or nonviable tissue. The following six cases, managed at our centre from July 2016 to October 2016, outline nuances in the diagnosis of invasive sinonasal mucormycosis and highlight the importance of timely surgical debridement and importance of endoscopic approach in complete clearance of disease in order to facilitate medical management to work. All cases included in this study were found to be immunocompromised and had unilateral severe diminution of vision due to periorbital extension of disease. Diagnostic nasal endoscopy revealed black-brown crust and tenacious pus filling up nasal cavity, erosion of turbinates and nasal septal perforation. One patient showed erosion of hard palate and eschar formation. CECT/MRI of PNS showed evidence of bony erosion and orbital involvement. Biopsy taken during nasal endoscopy confirmed the presence of mucormycosis. All patients were started on Liposomal Amphotericin B and broad spectrum antibiotics in renal corrected dosages and taken up for urgent endonasal endoscopic debridement. All paranasal sinuses were cleared and orbital decompression was done. Postoperatively all patients were continued on Liposomal Amphotericin B in renal corrected dosages for two-three weeks and being followed up monthly. One patient could not survive due to several co morbidities and severe immunocompromised status. Only one patient showed recurrence of disease on one month postoperative follow up. Five patients showed improvement in visual acuity. Sinonasal mucormycosis if inappropriately diagnosed and treated can be a fatal condition. Energetic diagnostic workup, combined with equally energetic management, surgical and management leads to favourable outcome.