Abstract
Diabetes is a well-known risk factor for invasive mucormycosis with rhinocerebral involvement. Acute necrosis of the maxilla is seldom seen and extensive facial bone involvement is rare in patients with rhino-orbital-cerebral mucormycosis. An aggressive surgical approach combined with antifungal therapy is usually necessary. In this report, we describe the successful, personalized medical and surgical management of extensive periorbital mucormycosis in an elderly diabetic, HIV-negative woman. Mono- or combination therapy with liposomal amphotericin B (L-AmB) and posaconazole (PSO) and withheld debridement is discussed. The role of aesthetic plastic surgery to preserve the patient's physical appearance is also reported. Any diabetic patient with sinonasal disease, regardless of their degree of metabolic control, is a candidate for prompt evaluation to rule out mucormycosis. Therapeutic and surgical strategies and adjunctive treatments are essential for successful disease management. These interventions may include combination therapy. Finally, a judicious multimodal treatment approach can improve appearance and optimize outcome in elderly patients.
Highlights
IntroductionsMucormycosis is an emerging angioinvasive infection caused by the ubiquitous filamentous fungi belonging to the Mucorales order [1]
Paola Di Carlo,1 Roberto Pirrello,2 Giuliana Guadagnino,1 Pierina Richiusa,3 Antonio Lo Casto,4 Caterina Sarno,5 Francesco Moschella,2 and Daniela Cabibi1
We describe the successful, personalized medical and surgical treatment of extensive periorbital mucormycosis complicated by internal carotid thrombosis in an elderly woman
Summary
Mucormycosis is an emerging angioinvasive infection caused by the ubiquitous filamentous fungi belonging to the Mucorales order [1] It is the third most common invasive fungal infection after candidiasis and aspergillosis and it is a devastating disease. Mucormycosis can occur in six different forms: rhinocerebral, pulmonary, cutaneous, gastrointestinal, disseminated, and uncommon presentation; the most frequent sites of infection are pulmonary, rhinocerebral, cutaneous, and disseminated [2]. This fungal infection is characterized by a rapid progression to disseminated infection and a high mortality rate, which is why early diagnosis and timely intervention lead to a better outcome [2, 4, 5]. Monotherapy with liposomal amphotericin B (L-AmB) or posaconazole (PSO) and combination of antifungal therapeutic strategies are discussed
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