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. 2016 Jan 12:16:10.
doi: 10.1186/s12886-016-0189-1.

A retrospective analysis of eleven cases of invasive rhino-orbito-cerebral mucormycosis presented with orbital apex syndrome initially

Nan Jiang  1 , Guiqiu Zhao  2 , Shanshan Yang  1 , Jing Lin  1 , Liting Hu  1 , Chengye Che  1 , Qian Wang  1 , Qiang Xu  1
Affiliations

A retrospective analysis of eleven cases of invasive rhino-orbito-cerebral mucormycosis presented with orbital apex syndrome initially

Nan Jiang et al. BMC Ophthalmol. .

Abstract

Background: 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. We report the cases of invasive ROCM presenting with OAS initially in order to raise the attention of clinicians.

Methods: We 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.

Results: A 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.

Conclusions: ROCM 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.

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Figures

Fig. 1
Fig. 1
Pre-operative aspect of patient exhibiting bilateral periorbital edema with facial swelling, exophthalmia, blepharoptosis,and Ocular purulent secretion
Fig. 2
Fig. 2
MRI presentations of mucormycosis presented with orbital apex syndrome. a: Axial T1WI MR shows a isointensity lesion in the left orbital apex;b: Axial T2WI MR shows a hypointensity lesion in the left orbital apex and high signal in the sphenoid sinus; c: Axial contrast-enhanced T1WI MR shows a enhancing lesion in the left orbital apex; d: Coronal contrast-enhanced T1WI MR shows a enhancing lesion in the left orbital apex
Fig. 3
Fig. 3
Nasal biopsy showing mycelial filaments of variable thickness and necrosis (PAS;×200)
See this image and copyright information in PMC

References

    1. Denning DW, Stevens DA. Antifungal and surgical treatment of invasive aspergillosis: review of 2,121 published cases. Rev Infect Dis. 1990;12(6):1147–1201. doi: 10.1093/clinids/12.6.1147. - DOI - PubMed
    1. Hagensee ME, Bauwens JE, Kjos B, Bowden RA. Brain abscess following marrow transplantation: experience at the Fred Hutchinson Cancer Research Center, 1984–1992. Clin Infect Dis. 1994;19(3):402–408. doi: 10.1093/clinids/19.3.402. - DOI - PubMed
    1. Pfaffenbach B, Donhuijsen K, Pahnke J, Bug R, Adamek RJ, Wegener M, et al. Systemic fungal infections in hematologic neoplasms. An autopsy study of 1,053 patients] Med Klin (Munich) 1994;89(6):299–304. - PubMed
    1. Gelston CD, Durairaj VD, Simoes EA. Rhino-orbital mucormycosis causing cavernous sinus and internal carotid thrombosis treated with posaconazole. Arch Ophthalmol. 2007;125(6):848–849. doi: 10.1001/archopht.125.6.848. - DOI - PubMed
    1. Pagano L, Ricci P, Tonso A, Nosari A, Cudillo L, Montillo M, et al. Mucormycosis in patients with haematological malignancies: a retrospective clinical study of 37 cases. GIMEMA Infection Program (Gruppo Italiano Malattie Ematologiche Maligne dell’Adulto) Br J Haematol. 1997;99(2):331–336. doi: 10.1046/j.1365-2141.1997.3983214.x. - DOI - PubMed

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