Rhino-Sino-Orbital Mucormycosis in Cholangiocarcinoma and Single-Centre Experience with Mucormycosis in Oncohematologic Patients: An Eight-Case Series

Background: Mucormycosis is a rapidly progressive and often fatal invasive fungal infection requiring immediate suspicion-driven diagnosis and treatment, particularly in immunocompromised patients. We report the first documented case of rhino-sino-orbital mucormycosis in a patient with recurrent intrahepatic cholangiocarcinoma and summarize our single-centre experience with eight cases of mucormycosis in oncohematologic patients. Methods: A 50-year-old woman developed rhino-sino-orbital mucormycosis after multimodal treatment for recurrent cholangiocarcinoma. Because of high clinical suspicion, imaging was performed before microbiological confirmation and antifungal therapy was initiated immediately through multidisciplinary management. Results: The patient survived 16 years after the initial cancer diagnosis, seven years after recurrence, and two years following mucormycosis. Our institutional series included eight cases with rhino-sino-orbital, pulmonary, cutaneous, and urinary tract involvement, most diagnosed after 2020, highlighting heterogeneous presentations and breakthrough infection despite prior antifungal exposure. Clinical experience gained from these cases contributed to early recognition and successful management of the present patient. Conclusions: To our knowledge, this is the first reported case of mucormycosis in cholangiocarcinoma. These findings emphasize that mucormycosis should be considered a medical emergency in patients with hematologic malignancies or solid tumors, and antifungal therapy should be initiated based solely on clinical suspicion without waiting for microbiological confirmation, even in atypical presentations.