Successful Management of Rhino-Orbital-Cerebral Mucormycosis in a Child with Acute-on-Chronic Kidney Disease and Malnutrition: Case report and literature review

Abstract

Mucormycosis is a very rare fungal infection in children. It is caused by opportunistic fungi and mainly affects immunocompromised patients. Early diagnosis is very important for a good outcome. Successful management requires the reversal of the underlying predisposing risk factors, surgical debridement and prompt administration of active antifungal agents, with liposomal amphotericin B being the first-line therapy. This case, to the best of the authors' knowledge, is the first rhino-orbital-cerebral mucormycosis to be reported on among Omani children. We highlight the importance of early diagnosis and prompt surgical and medical interventions in achieving a satisfactory outcome and review the published literature in regard to the management.

Keywords: Liposomal amphotericin B; Malnutrition; Mucormycosis; Oman; Posaconazole; Proptosis; Rhizopus; Sinusitis.

Figure 1

Photograph showing mild proptosis, swelling and redness of the left eye and multiple pustular lesions on the left eyebrow, left side of the forehead and nasal bridge.

Figure 2

A: Photograph showing very thick white lesion coating the hard palate with central dark discoloration, measuring 2 × 2 cm. B: The oral cavity on follow-up showing healthy and clear margin of the lesion.

Figure 3

Axial computed topography orbit showing left eye proptosis (star), maxillary and ethmoid sinusitis (arrows) with subtle rarefaction of the left lamina papyracea.

Figure 4

Section of nasal biopsy at ×200 magnification showing blood vessel invasion by periodic acid-Schiff stain, positive non-septate, broad, ribbon-like fungal hyphae (arrow).