眼窩尖端症候群を呈したRhinocerebral Mucormycosisの1例

A Case of Rhinocerebral Mucormycosis Presenting Orbital Apex Syndrome

I．はじめに

　Rhinocerebral mucormycosisは副鼻腔内に発生し，頭蓋内外へ急速伸展する真菌感染症である．今回われわれは，眼窩尖端症候群で発症し，術前診断を行えず予後不良の転帰をとった本症の1例を経験したので，その診断，治療について文献的考察とともに報告する．

A 62-year-old man with untreated diabetes complained of diplopia and headache. Neurological examina-tion demonstrated left abducens nerve palsy. MRI showed a mass lesion in the left orbital apex. Total leftophthalmoplegia and visual loss rapidly developed in the next two weeks. A craniotomy was performed todecompress the orbital apex and remove the mass. The optic nerve was tightly encased by fibrous tissue.The pathological diagnosis was mucormycosis. Systemic administration of amphotericin B and fluconazolewas started immediately. But the lesion rapidly invaded the cavernous sinus and occluded the left internalcarotid artery. Finally, the patient died with intracranial extension of mucormycosis four months after theoperation.

Rhinocerebral mucormycosis is a rapidly progressive fatal disease. Successful treatment seems to bebased on early diagnosis, control of the underlying disease, radical surgical resection, and systemic admin-istration of amphotericin B. Mucormycosis should be considered as a differential diagnosis of orbital apexsyndrome.