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. 2015 Aug;45(4):169-174.
doi: 10.4274/tjo.82474. Epub 2015 Aug 5.

Rhino-orbital Mucormycosis: Clinical Findings and Treatment Outcomes of Four Cases

Şeyda Karadeniz Uğurlu  1 , Sedat Selim  1 , Aylin Kopar  2 , Murat Songu  2
Affiliations

Rhino-orbital Mucormycosis: Clinical Findings and Treatment Outcomes of Four Cases

Şeyda Karadeniz Uğurlu et al. Turk J Ophthalmol. 2015 Aug.

Abstract

In this case report, we present the clinical findings and therapeutic outcomes of four rhino-orbital mucormycosis patients. The four patients (1 female, 3 male; age range, 55-77 years) all had diabetes mellitus and two also had chronic renal failure. All patients exhibited proptosis, sinusitis, and dark-colored lesions on the nasopharynx and/or hard palate; three patients had ipsilateral peripheral facial paralysis. Visual acuity was no light perception in the two patients with severe orbital involvement and 0.8 in two patients with limited orbital involvement. Histopathological examination of the hard palate, nasopharynx or sinus biopsy revealed typical Mucor hyphae. Systemic liposomal amphotericin B was initiated in all patients. The patients with limited ocular involvement received amphotericin B both intravenously and by local irrigation; both patients had complete recovery. The other two patients underwent orbital exenteration; one patient died after declining systemic treatment postoperatively. Rapid diagnosis and treatment are important for the survival of rhino-orbital mucormycosis patients. With orbital involvement, surgical debridement and systemic and local treatment with antifungal agents may help avoid mutilating surgery like exenteration.

Keywords: Mucormycosis; exenteration; orbital involvement.

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Conflict of interest statement

No conflict of interest was declared by the authors. Financial Disclosure: The authors declared that this study received no financial support.

Figures

Figure 1
Figure 1. Case 1, palate biopsy showing thick-walled, large diameter (6-25 micron), nonparallel branching hyphae typical of mucormycosis (Hematoxylin&eosin stained)
Figure 2
Figure 2. Case 1, infiltration of the lower side of the orbit (a, white arrow) and probable infiltration of the apex and dura through the inferior orbital fissure (b)
Figure 3
Figure 3. Case 2, infiltration of the right retroorbital tissue, severe proptosis and conical deformation of the posterior globe
Figure 4a
Figure 4a. Case 2, exenteration material
Figure 4b
Figure 4b. Case 2, necrotic changes in the socket and continued suppuration at the apex are visible following exenteration
Figure 5
Figure 5. (a and b) Case 3, coronal magnetic resonance imaging images of the orbit showing increased signal intensity of both intraconal and extraconal fat, edematous thickening of the recti and orbital apex infiltrationa
Figure 6
Figure 6. Case 3, patient exhibiting marked proptosis and total ophthalmoplegia of the left eye
Figure 7
Figure 7. Case 4, magnetic resonance imaging images of patient number 4 who underwent left maxillectomy and hard palate resection. The area of suspected involvement in the inferior wall orbital wall is shown with a white arrow
Figure 8
Figure 8. Case 4, patient preoperatively (a) and on postoperative day 2 after surgical debridement and amphotericin B irrigation (b). Note that there is marked improvement in eyelid edema and hyperemia
See this image and copyright information in PMC

References

    1. Roden MM, Zaoutis TE, Buchanan WL, Knudsen TA, Sarkisova TA, Schaufele RL, Sein M, Sein T, Chiou CC, Chu JH, Kontoyiannis DP, Walsh TJ. Epidemiology and outcome of zygomicosis: a review of 929 reported cases. Clin Infect Dis. 2005;41:634–653. - PubMed
    1. Yohai RA, Bullock JD, Aziz AA, Markert RJ. Survival factors in rhino-orbital-cerebral mucormycosis. Surv Ophthalmol. 1994;39:3–22. - PubMed
    1. Ferguson BJ. Mucormycosis of the nose and paranasal sinuses. Otolaryngol Clin North Am. 2000;33:349–365. - PubMed
    1. Ferry AP, Abedi S. Diagnosis and management of rhino-orbitocerebral mucormycosis (Phycomycosis). A report of 16 personally observed cases. Ophthalmology. 1993;90:1096–1104. - PubMed
    1. Gumral R, Yildizoglu U, Saracli MA, Kaptan K, Tosun F, Yildiran ST. A case of rhinoorbital mucormycosis in a leukemic patient with a literature review from Turkey. Mycopathologia. 2011;172:397–405. - PubMed

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