Multi-disciplinary Approach in Management of Rhino-orbito-cerebral Mucormycosis in Resource-poor Setting in Sub-saharan Africa: A Case Report

Abstract

Rhino-orbito-cerebral mucormycosis (ROCM) is an uncommon acute aggressive fungal infection occurring in several immunocompromised states including diabetes which is the most common predisposing factor. In this case report we present the clinical finding, therapeutic challenges and outcome in a 44 years old male type II diabetic patient. Patient first presented to the ortorhinolaryngologist with complaints of nasal discharge, postnasal drip, cough, hyposmia, facial pains, and intermittent nasal obstruction. He had bilateral intranasal antrostomy, upon X-ray confirmation of homogenious opacity of the left maxillary antrum and mucosal thickening of the right antrum. Fungal study of the specimen revealed mucormycosis. Six months later he presented with perception of light (PL) vision in the right eye and non-perception of light (NPL) in the left eye. There was mild lid edema in the right eye. There was marked proptosis associated with external ophthalmoplegia suggestive of orbital apex syndrome. The conjunctiva was keratinized and the cornea necrotic and opaque. The left eye enucleation and nasal exploration were done. The patient objected to taking amphotericn B, the drug of choice for this condition because of his previous adverse reaction experience to the drug. Posacornazole, the second line drug could not be assessed, posing a great therapeutic challenge in the effective management of this case. The patient was later referred for neurosurgical management but was reported to have died at a tertiary health facility in Abuja.