A C Kothari1, S Shroff1. 1. St John's Medical College Hospital, Bangalore , India.
Abstract
BACKGROUND: Rhinoorbito-cerebral mucormycosis is an uncommon and acute fungal infection which runs a fulminant course. Uncontrolled diabetes mellitus is the most common predisposing factor. AIM: To assess the outcome of a poorly controlled diabetic with Rhinoorbito-cerebral mucormycosis using a multi-modality management. METHODOLOGY: We report a case of a 57-year old male who presented to us with proptosis and total external ophthalmoplegia diagnosed with rhino-orbito-cerebral mucormycosis. Patient was started on conventional intravenous amphotericin B to which he developed systemic toxicity. As an alternative, a combination therapy of oral posacanazole along with peribulbar amphotericin B injections for a more localised effect was initiated. RESULTS: He had a favourable outcome with dramatic improvement in vision and marginal recovery of extra ocular movements within 20 days of initiation of combination therapy. CONCLUSION: Rhinoorbito-cerebral mucormycosis is a major diagnostic dilemma with quick progression and a high mortality. Prompt medical management with a multi-modality approach can save the patient from orbital exenteration.
BACKGROUND:Rhinoorbito-cerebral mucormycosis is an uncommon and acute fungal infection which runs a fulminant course. Uncontrolled diabetes mellitus is the most common predisposing factor. AIM: To assess the outcome of a poorly controlled diabetic with Rhinoorbito-cerebral mucormycosis using a multi-modality management. METHODOLOGY: We report a case of a 57-year old male who presented to us with proptosis and total external ophthalmoplegia diagnosed with rhino-orbito-cerebral mucormycosis. Patient was started on conventional intravenous amphotericin B to which he developed systemic toxicity. As an alternative, a combination therapy of oral posacanazole along with peribulbar amphotericin B injections for a more localised effect was initiated. RESULTS: He had a favourable outcome with dramatic improvement in vision and marginal recovery of extra ocular movements within 20 days of initiation of combination therapy. CONCLUSION:Rhinoorbito-cerebral mucormycosis is a major diagnostic dilemma with quick progression and a high mortality. Prompt medical management with a multi-modality approach can save the patient from orbital exenteration.
Entities:
Keywords:
Amphotericin B; Good outcome; India; Mucormycosis; Posaconazole; Uncontrolled diabetes
Authors: A Bhansali; S Bhadada; A Sharma; V Suresh; A Gupta; P Singh; A Chakarbarti; R J Dash Journal: Postgrad Med J Date: 2004-11 Impact factor: 2.401
Authors: Brad Spellberg; Thomas J Walsh; Dimitrios P Kontoyiannis; John Edwards; Ashraf S Ibrahim Journal: Clin Infect Dis Date: 2009-06-15 Impact factor: 9.079