case_images: PMC3336238_01
case_images: (a) CT scan of patient with invasion of left paranasal sinuses and orbit. (b) Necrotic sinus tissue found on endoscopy.
case_images: CRIM.ID2011-181782.001.jpg
case_images: PMC3336238_01_CRIM.ID2011-181782.001.jpg
case_images: fig1
case_images: Because of persistent fever, and the sinus maxillary clinical signs, a CT scan of the head was performed; it showed a solid image inside the left maxillary sinus, proptosis of the left eyeball, and destruction of the structures adjacent to the nose (Figure 1(a)). Following these findings, a nasal endoscopy was performed promptly, and it showed an extensive necrosis of the left medial turbinate (Figure 1(b)).
case_images: Biopsy with silver stain showing large pauciseptate hyphae invading tissue.
case_images: CRIM.ID2011-181782.002.jpg
case_images: PMC3336238_01_CRIM.ID2011-181782.002.jpg
case_images: fig2
case_images: An incisional biopsy report showed necrosis and hemorrhage with nonseptate hyphae 90  degree branched (Figure 2), and Mucor sp. was identified on culture (Figure 3) since the first procedure intranasal amphotericin was instilled.
case_images: Sporangiophores with big sporangia, with no apophysis, rhizoids or stolones, compatible with Mucor sp.
case_images: CRIM.ID2011-181782.003.jpg
case_images: PMC3336238_01_CRIM.ID2011-181782.003.jpg
case_images: fig3
case_images: An incisional biopsy report showed necrosis and hemorrhage with nonseptate hyphae 90  degree branched (Figure 2), and Mucor sp. was identified on culture (Figure 3) since the first procedure intranasal amphotericin was instilled.
case_images: Aspect of patient with periorbital edema and ecchymosis of the surrounding skin.
case_images: CRIM.ID2011-181782.004.jpg
case_images: PMC3336238_01_CRIM.ID2011-181782.004.jpg
case_images: fig4
case_images: On arrival her vital signs were unstable, she was found to have facial asymmetry, periorbital edema, and bilateral proptosis (mainly right eye) with ecchymosis of the surrounding skin, her right pupil did not react to light stimuli (Figure 4).
case_images: (a) KOH exam showing nonseptate hyphae branched at 90 degrees. (b) Sporangiophores with sporangia and underdeveloped stolones, compatible with Rhizomucor sp.
case_images: CRIM.ID2011-181782.005.jpg
case_images: PMC3336238_01_CRIM.ID2011-181782.005.jpg
case_images: fig5
case_images: Postmortem, a nasal biopsy and swab were taken and found compatible with rhinocerebral invasive zygomycosis due to the observation of nonseptate hyphae branched at 90  degrees (Figure 5(a)). Two days later a zygomycete was grown and identified as Rhizomucor spp. (Figure 5(b)).