Absidial rhino-orbital mucormycosis complicating the management of ocular trauma

Abstract

Absidia are rare causes of rhino-orbital mucormycosis, which is generally associated with Rhizopus infection. A 61 -year-old man sustained ocular trauma to his left eye. His traumatic optic neuropathy was treated with high-dose corticosteroids and with optic nerve sheath and optic nerve canal decompressions. A retinal dialysis was also corrected surgically. Two weeks later, the patient developed an orbital cellulitis with extensive upper eyelid necrosis. Biopsies revealed necrotic tissues on two occasions. Absidia and Peptostreptococcus were isolated from both specimens. Combined intensive amphotericin B and antibacterial therapy and two extensive surgical debridements successfully treated the polymicrobial mucormycosis, allowing eventual skin-graft repair.Intensive corticosteroid use appeared to be the principal inducing factor in this case, compounded by surgery involving the sinuses. The pathogenesis appeared entirely iatrogenic, complicating the management of ocular trauma. The characteristic constellation of signs and rapid disease progression were absent in this case, but this may reflect the absidial etiologic agent. Mucormycosis diagnosis requires special biopsy preparation. With early diagnosis and intensive medical and surgical therapy, the prognosis of rhino-orbital (and rhinocerebral) mucormycosis continues to improve.