Lethal rhinocerebral phycomycosis in a healthy adult: a case report and review of the literature.

A lethal case of rhino-orbital-cerebral phycomycosis (mucormycosis) in an otherwise healthy man is presented. The clinical, radiologic, and ante mortem surgical pathology associated with microbiologic examinations failed to yield the diagnosis of fungal infection as the cause of a clinical presentation of acute sphenoid sinusitis with a fulminant cavernous sinus thrombosis. No similar case report was found in review of the literature. There is a need for a high degree of suspicion in this condition to improve the uniformly poor prognosis in this devastating infectious disease. Emphasis is placed on the necessity for early tissue or microbiologic diagnosis with appropriate histologic stains and fungal cultures. Treatment consists of extensive surgical excision of all necrotic or questionably viable tissue in conjunction with alternate-day amphotericin B therapy.