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

Rituximab is a cd20 depleting agent, widely used as an off-label disease-modifying 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. 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. the present report indicates a case of spms treated with rituximab, who developed rhino-sino-cerebral mucormycosis.