Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_2645_Библиотеки_им_академика_М_И_Перельмана

and may be lethal if not detected early. Patients with mucormycosis almost invariably have some degree of immunocompromise, such as diabetes mellitus, long-term corticosteroid therapy, neutropenia associated with che­motherapy for hematologic malignancy, or end-stage renal disease. Occasional cases of sinonasal infection with Asper- gillus spp. have been reported in patients with untreated HIV/AIDS. The initial symptoms may be similar to those of acute bacterial rhinosinusitis, although facial pain is often more severe. Nasal drainage is typically clear or straw-colored, rather than purulent, and visual symptoms may be noted at presentation in the absence of significant nasal findings. On examination, the classic finding of mucormycosis is a black eschar on the middle turbinate, but this finding is not universal and may not be apparent if the infection is deep or high within the nasal bones. Often the mucosa appears normal or simply pale and dry. This may be noted on the hard palate as well. Early diagnosis requires suspicion of the disease and nasal biopsy with sil­ver stains, revealing broad nonseptate hyphae within tis­sues and necrosis with vascular occlusion. Imaging, such as CT or MRI, may initially show only soft tissue changes. Consequently, biopsy and ultimate debridement should be based on the clinical setting rather than radiographic dem­onstration of bony destruction or intracranial changes.