Lugata John, Rapheal Ashley, Makower Laetitia, Mchome Bariki, Batchu Nasra
Department of Obstetrics and Gynecology, Kilimanjaro Christian Medical Centre, Moshi, Tanzania; Faculty of Medicine, Kilimanjaro Christian Medical University College, Moshi, Tanzania.
Department of Obstetrics and Gynecology, Kilimanjaro Christian Medical Centre, Moshi, Tanzania.
Int J Surg Case Rep. 2025 Jan;126:110834. doi: 10.1016/j.ijscr.2025.110834. Epub 2025 Jan 3.
Rhinocerebral mucormycosis (RM) is a rare and severe condition caused by filamentous fungi, characterized by infection of the nose, paranasal sinuses, and brain. It is the most common and fatal clinical form of mucormycosis, accounting for 50 % of reported cases. RM is seldom reported during the postpartum period. This case report presents a rare instance of RM following childbirth and reviews the most recent literature, highlighting the limited cases documented globally and even fewer within Africa. The aim is to contribute to the existing body of knowledge and provide guidance for clinicians managing similar cases. Notably, this is the first case report to describe this rare condition postpartum in Sub-Saharan Africa, specifically in Tanzania.
In this case report from Northern Tanzania, we report a patient who was diagnosed with rhinocerebral mucormycosis following spontaneous normal delivery. A 34-year- old female presenting with a history of severe headache for 3 weeks, associated with blurry vision and later on completely loss of vision, dizziness and generalized body weakness. A Computed tomography scan (CT) of the head revealed a hypodense lesion of the frontal lobe with an extension compressing the optic chiasm. Magnetic Resonance Imaging (MRI) of the brain revealed hyperintensities in the frontal lobe, thalamus, periorbital regions and nasal sinuses. Treatment was stopped due to an acute kidney injury and the patient self-discharged against medical advice. Since, the patient has not returned for follow up.
In this report, we discuss the rarity of this condition, the literature surrounding similar reports, and the many challenges that arise in the management of rhinocerebral mucormycosis especially in limited resource settings. Currently, reports in the literature are limited. A greater evidence base is required to support the development of effective treatments which would further improve patient outcomes.
Rhinocerebral mucormycosis is potentially fatal disease which progresses rapidly. Early detection and prompt treatment are critical for survival. Antifungal therapy in combination with intensive surgical debridement facilitates improved outcomes for patients. The incidence of rhinocerebral mucormycosis cases in Tanzania has not been studied extensively. More studies are required with specific focus on patients with high risk underlying conditions such diabetes, and hematological malignancies.
鼻脑型毛霉菌病（RM）是一种由丝状真菌引起的罕见且严重的疾病，其特征为鼻腔、鼻窦和脑部感染。它是毛霉菌病最常见且致命的临床类型，占报告病例的50%。产后很少有鼻脑型毛霉菌病的报告。本病例报告展示了一例产后罕见的鼻脑型毛霉菌病病例，并回顾了最新文献，强调了全球范围内记录的病例有限，在非洲更是少之又少。目的是为现有知识体系做出贡献，并为处理类似病例的临床医生提供指导。值得注意的是，这是撒哈拉以南非洲地区，特别是坦桑尼亚首例描述产后这种罕见疾病的病例报告。
在这份来自坦桑尼亚北部的病例报告中，我们报告了一名在自然顺产之后被诊断为鼻脑型毛霉菌病的患者。一名34岁女性，有3周严重头痛病史，伴有视力模糊，随后完全失明，并伴有头晕和全身乏力。头部计算机断层扫描（CT）显示额叶有低密度病变，其扩展压迫视交叉。脑部磁共振成像（MRI）显示额叶、丘脑、眶周区域和鼻窦有高信号。由于急性肾损伤，治疗中断，患者不听从医嘱自行出院。此后，患者未再回来复诊。
在本报告中，我们讨论了这种疾病的罕见性、围绕类似报告的文献以及在鼻脑型毛霉菌病管理中出现的诸多挑战，特别是在资源有限的环境中。目前，文献中的报告有限。需要更多的证据基础来支持有效治疗方法的开发，这将进一步改善患者的预后。
鼻脑型毛霉菌病是一种可能致命的疾病，进展迅速。早期检测和及时治疗对生存至关重要。抗真菌治疗联合强化手术清创有助于改善患者的预后。坦桑尼亚鼻脑型毛霉菌病病例的发病率尚未得到广泛研究。需要更多的研究，尤其关注患有糖尿病和血液系统恶性肿瘤等高风险基础疾病的患者。
