Fatal rhinocerebral mucormycosis with intracavernous carotid aneurysm and thrombosis: a late complication of transsphenoidal surgery?

Acta Neurol Belg. 2013 Jun;113(2):179-84. doi: 10.1007/s13760-012-0151-9. Epub 2012 Nov 8.

Abstract

Mucormycosis is a rare opportunistic fungal infection. Rhinocerebral form of the disease mainly affects diabetic or immunocompromised patients. Mucormycosis have specific tropism for blood vessels leading to mucorthrombosis and less often to mycotic aneurysms. We report on a patient initially presenting with a severe sphenoid sinusopathy, who progressively evolved to cavernous sinus syndrome, internal carotid aneurysm followed by spontaneous thrombosis, chronic meningitis and ultimately fatal hypertensive hydrocephalus. Necropsy revealed a purulent infiltrate containing thin-walled, aseptate, right-angle branching, hyphae consistent with mucormycosis. His only relevant previous medical history was a transsphenoidal surgery for pituitary macroadenoma 21 years before. We hypothesize that post-surgical mucosal changes in the sphenoid sinus have been a favoring factor for delayed and invasive mucor infection.

Publication types

  • Case Reports

MeSH terms

  • Aneurysm / etiology*
  • Aneurysm / pathology
  • Carotid Artery Diseases / etiology*
  • Carotid Artery Diseases / pathology
  • Cavernous Sinus / microbiology
  • Cavernous Sinus / pathology
  • Cavernous Sinus Thrombosis / etiology*
  • Cavernous Sinus Thrombosis / pathology
  • Fatal Outcome
  • Humans
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Mucormycosis / etiology*
  • Mucormycosis / pathology
  • Postoperative Complications / etiology*
  • Postoperative Complications / pathology
  • Sphenoid Bone / pathology