Nasopharyngeal Mucormycotic Osteitis: A New Syndrome Characterized by Initial Presentation of Multiple Cranial Nerve Palsies

Abstract

Rhinocerebral mucormycosis, a highly lethal fungal infection of the head and neck, is commonly recognized by its classic appearance. Two cases of this newly recognized clinical syndrome with isolated unilateral peripheral cranial nerve V, VI, VII, IX, X, XI, and XII palsies and initial sparing of the eighth cranial nerve are presented. Examination revealed that each patient had ulceration of the nasopharynx and osteitis of the base of the skull. Nose, orbits, paranasal sinuses, and intracranial nervous systems were initially spared. The cause of this obscure cranial nerve paralysis was diagnosed from biopsy specimens of the nasopharyngeal tissues and the demonstration of nonseptate hyphae. Review of the literature did not indicate that this syndrome had previously been recognized. The name nasopharyngeal mucormycotic osteitis is suggested.