Abstract
Rhino-orbital-cerebral mucormycosis (ROCM) is an acute, often fatal, fungal infection caused by members of the class Zygomycetes and the order Mucorales. The genus Rhizopus accounts for most cases of ROCM. The disease is characterized by fungal hyphal invasion of blood vessels resulting in thrombosis and infarction of the nasal, paranasal sinus, orbital, and cerebral tissues. The most commonly associated condition is diabetes mellitus; other associated conditions include immunocompromised states, renal disease, deferoxamine use and acidotic states. The most frequent sites of infection are pulmonary, rhinocerebral, cutaneous and disseminated. Rhino-orbital and Rhino-cerebral are two forms of the disease. As such the condition is a medical emergency. Early recognition and treatment are essential because it may lead to death in a few days. CROP usually begins in the palate or paranasal sinuses and rapidly spreads to the orbital contents. Proptosis, loss of vision and ophthalmoplegia occur and death from cerebral involvement commonly ensues. The fungus tends to invade arteries and cause thrombosis and tissue infarction. Rhizopus is the most commonly isolated genus in CROP, accounting for almost all cases. The diagnosis can be strongly suspected by the characteristic clinical manifestations. Therapy includes the treatment of the underlying disease, surgical excision of the necrotic tissue containing fungal elements and the systemic administration of amphotericin-B. Here we report the clinical features of a 32-years-old man presented mucormycosis.
Highlights
A 32-years-old male patient presented a history of pain in the nose and defective vision in the left eye since one week
All other lab investigations are found to be normal. His nasal swab and maxillary and ethmoid sinus curettages were received in the microbiology laboratory for KOH mounts and fungal cultures to check for mucormycosis
Rhino-Orbital Mucormycosis (ROM) is a rare disease with an overall prevalence in 0.15% of the diabetics
Summary
A 32-years-old male patient presented a history of pain in the nose and defective vision in the left eye since one week. He was apparently all right one week prior. Pt was dilated for fundus examination, and BE fundus found to be normal. All other lab investigations are found to be normal His nasal swab and maxillary and ethmoid sinus curettages were received in the microbiology laboratory for KOH mounts and fungal cultures to check for mucormycosis. The microscopic examination of the biopsy material and the nasal discharge was done in 10% KOH wet mounts. It showed the characteristic broad, aseptate, branched hyphae (Figures 2, 3). The patient was started on an intravenous insulin infusion and amphotericin B at 0.3 mg/kg/day and this was gradually increased to 1 mg/kg/day with the monitoring of the serum electrolytes and the renal functions
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