EMBlog Mayo Clinic - March 11. 2015 - Posted by Daniel Cabrera MD.
"Rhinocerebral mucormycosis (RCM) is one of those entities that you really, really don’t want your patients to have. I have seen a few patients die within hours of the diagnosis.
Mucormycosis is an invasive fungal infection (Rhizopus oryzae) that affects almost exclusively patients with uncontrolled diabetes, immunosuppression or with active malignancies. The pathophysiology is not completely understood, but involves the inhalation of soil spores, nesting the in sinuses mucosa and rapid growth. The mechanism allowing the transformation into an invasive infection appears to require elevated glucose levels, acidosis and iron overload; in other words, an immunocompromised patient with DKA is the perfect host for the invasion.
The initial presentation can be difficult to distinguish from a more benign entity such as sinusitis, however the presentation is severe and the progression of the disease is typically very fast with evidence of invasion outside the nasal cavity (palate), commonly followed by systemic deterioration and neurological symptoms, altered mental status and nerve palsies. A severe or rapidly progressing sinusitis in predisposed patient should raise the alarm of rhinocerebral mucormycosis and warrant aggressive diagnosis and management."
http://emblog.mayo.edu/discussion/rhinocerebral-mucormycosis-battling-the-alien-within/