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

• Published in: Case reports in clinical practice (Online) Vol. 7; no. 6
• Main Authors: Koosha, Mohsen, Mehrparvar, Golfam, Paybast, Sepideh
• Format: Journal Article
• Language: English
• Published: Tehran University of Medical Sciences 15-03-2023
• Subjects: B-Lymphocytes; Mucormycosis; Multiple sclerosis; Rituximab
• ISSN: 2538-2683; 2538-2691
• DOI: 10.18502/crcp.v7i6.12278

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.