Abstract
BackgroundRhino-orbito-cerebral mucormycosis(ROCM) is an invasive fungal infection that usually occurs in immunocompromised patients and sometimes presents as orbital apex syndrome(OAS) initially. It is rapidly fatal without an early diagnosis and treatment. We report the cases of invasive ROCM presenting with OAS initially in order to raise the attention of clinicians.MethodsWe retrospectively investigated eleven cases of invasive ROCM presenting initially with OAS admitted between January 2006 and December 2013. We analyzed clinical features, results of laboratory and radiological examinations, nasal endoscopy, aggressive surgical excision and debridement, and medical management outcomes of each case.ResultsA total of eleven cases of invasive ROCM with OAS as an initial sign were presented. Mucormycosis was accompanied by type II diabetes mellitus in nine cases, renal transplant in one case, and injury caused by traffic accident in one case. Anterior rhinoscopy revealed palatine or nasal necrotic lesions in all patients, and transethmoidal optic nerve decompression was carried out in three patients at the same time. CT scan revealed rhino-orbital-cerebral involvement in every patient. All patients were given intravenous amphotericin B. Nine patients underwent surgical debridement of necrotic tissue. Three patients survived.ConclusionsROCM is a severe, emergent and fatal infection requiring multidisciplinary management. It may often present with OAS initially. For ophthalmologist, mucormycosis must be considered in immunocompromised patients presenting with OAS initially, and anterior rhinoscopy is imperative before hormonotherapy, even in the cases absent of ketoacidosis induced by diabetes mellitus.
Highlights
Rhino-orbito-cerebral mucormycosis(ROCM) is an invasive fungal infection that usually occurs in immunocompromised patients and sometimes presents as orbital apex syndrome(OAS) initially
The diagnosis is often made late and relies on anatomopathological and mycological examinations, especially for some patients presenting with atypical symptoms initially for example swelling lid, nasal stuffiness, vision loss et al Rhino-orbital-cerebral mucormycosis (ROCM) may be rapidly fatal if not recognized early and treated promptly
One patient presented with renal transplant, and one was injured by traffic accident .Of 11 cases of mucormycosis with rhino-orbito-cerebral involvement, all had Orbital apex syndrome (OAS)
Summary
Rhino-orbito-cerebral mucormycosis(ROCM) is an invasive fungal infection that usually occurs in immunocompromised patients and sometimes presents as orbital apex syndrome(OAS) initially. It is rapidly fatal without an early diagnosis and treatment. Mucormycosis is the second most frequent fungal infection following aspergillus [1,2,3] This fungal infection can rapidly progress in individuals who are immunologically or metabolically compromised through vascular thrombosis or. The diagnosis is often made late and relies on anatomopathological and mycological examinations, especially for some patients presenting with atypical symptoms initially for example swelling lid, nasal stuffiness, vision loss et al Rhino-orbital-cerebral mucormycosis (ROCM) may be rapidly fatal if not recognized early and treated promptly.
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