Mucormycosis of the head and neck.

Mucormycosis of the head and neck is the most common form of infection by the order Mucorales, accounting for up to half of all cases. About 70% of rhinocerebral cases develop in diabetic patients. Less often, rhinocerebral mucormycosis occurs in solid organ transplant recipients, those with prolonged neutropenia, and those on deferoxamine therapy. Recently, rhinocerebral disease has been increasingly recognized in patients undergoing hematopoietic stem cell transplantation. A growing number of cases have presented as breakthrough infection in patients receiving voriconazole. The mortality rate of rhinocerebral mucormycosis has remained at 30% to 70% despite aggressive therapy. Early initiation of treatment substantially improves outcome, underscoring the need to maintain a high index of suspicion and promptly biopsy potential lesions. Surgical excision of necrotic tissue is essential. Lipid formulations of amphotericin B have become the standard treatment for mucormycosis. Posaconazole is useful as salvage therapy, but cannot be recommended yet as primary therapy.