Case report of a patient with rhino-orbito-cerebral mucormycosis

Introduction:

The rhino-orbito-cerebral mucormycosis (ROCM) is a rare and life-threating fungal infection of the nose, paranasal sinuses and orbita with cerebral involvement. Patients with opportunistic infection with Mucorales, most Rhizopus oryzae, show an orbital apex syndrome. Main risk factors are diabetes mellitus, usually in combination with ketoazidosis or renal insufficiency, hematopoetic diseases and immunosuppression. The mortality rate is between 30% and 85%.

Methods:

Case report of a patient with a rhino-orbito-cerebral mycormycosis; literature research.

Case report:

A 52-year-old male patient with type 1 diabetes mellitus presented with retro-orbital pain, ophtalmoplegia and visual loss from another hospital. The MRI showed an obstructed right sinus maxillary with orbital involvement. Sinus surgery with orbital decompression was performed immediately. The microbial probe showed the fungus Rhizopus azirrhus. We initiated an intravenous therapy with Amphotericin B and performed a radical removal of fungal associated tissue. The antifungal therapy was complemented by Isavuconazole (higher concentration in cerebrospinal fluid), which the patient received intravenously for several months.

Conclusion:

The rhino-orbito-cerebral mucormycosis is a rare and often lethal fungal infection that should be considered as a differential diagnosis in case of rhino-orbital infection. It requires early diagnosis, an interdisciplinary approach with aggressive surgery and intravenous antimycotic therapy over several weeks to months.

Publication History

Publication Date:
18 April 2018 (online)