Rhino-Sino-Cerebral Mucormycosis Associated with Long-Term Rituximab Therapy in Multiple Sclerosis: A Case Report and Review of the Literature

Mohsen Koosha; Golfam Mehrparvar; Sepideh Paybast

doi:10.18502/crcp.v7i6.12278

Mohsen Koosha Neurosurgery Department, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Golfam Mehrparvar Neurosurgery Department, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Sepideh Paybast Multiple Sclerosis Research Center, Neuroscience Institute; Tehran University of Medical Sciences, Tehran, Iran.

DOI: https://doi.org/10.18502/crcp.v7i6.12278

Keywords: Multiple sclerosis; Rituximab; B-Lymphocytes; Mucormycosis

Abstract

Introduction: Rituximab is a CD20 depleting agent, widely used as an off-label diseasemodifying treatment (DMT) in treating multiple sclerosis (MS). The present study aimed to report the first case of rhino-sino-cerebral mucormycosis in a patient with secondary progressive MS (SPMS), treated with rituximab.

Case Report: The patient was a 38-year-old man with a history of SPMS treated with rituximab, who developed subacute left vision loss and impaired ocular movement. He also mentioned a concomitant severe headache and cheek swelling. Based on the brain and orbital magnetic resonance imaging (MRI) findings, rhino-sino-cerebral mucormycosis was suspected. Subsequent endoscopic examination confirmed the diagnosis. He underwent medical treatment with amphotericin B liposomal and surgical debridement leading to a significant clinical recovery. He was eventually discharged home with a solid recommendation to discontinue rituximab.

Conclusion: The present report indicates a case of SPMS treated with rituximab, who developed rhino-sino-cerebral mucormycosis.