Fungal Orbital Cellulitis: Presenting Features, Management and Outcomes at a Referral Center

Abstract

Purpose To report a series of patients with fungal orbital cellulitis who underwent exenteration surgery and describe presenting features, management and outcomes at a referral center. Methods Retrospective case series. Results From November 2011 to March 2014, four patients underwent orbital exenteration for fungal orbital cellulitis at the University of Illinois. Three patients had mucormycosis and one had aspergillosis. All patients were treated with intravenous antifungals and underwent orbital exenteration. Two patients were successfully treated with supplemental intra-orbital catheter delivery of amphotericin B. Presenting visual acuity in the affected eye ranged from 20/25 to no light perception. Some level of ophthalmoplegia was present in three patients. Significantly elevated intraocular pressure was found in two patients. All patients with mucormycosis were found to have uncontrolled diabetes mellitus. One patient had a history of myelodysplastic syndrome, chronic hepatitis C infection, polysubstance abuse and Crohn’s disease. Another patient had a history of alcoholic liver cirrhosis, Crohn’s disease treated with systemic immunosuppression and renal cell carcinoma. The patient with aspergillosis had myelodysplastic syndrome and portal hypertension, and the initial presentation resembled giant cell arteritis. Two of four patients died during their hospitalization. Conclusions Fungal orbital cellulitis has a high mortality rate despite aggressive antifungal treatment and orbital exenteration performed soon after the diagnosis is confirmed. Patients often have a history of immunosuppression and the onset may be insidious. There must be a high rate of suspicion for fungal orbital cellulitis given the appropriate signs and medical history in order to avoid treatment delay.

Hidden Germ of the Immunocompromised: A Case of Fungal Orbital Cellulitis

“…In mucormycosis, Rhizopus sp. is the most common causative agent (Farooq et al 2015), as seen in this case.…”

“…The mechanism of spread of Rhizopus sp. is facilitated by high amount serum iron and glucose (Farooq et al 2015). Uncontrolled diabetes mellitus remain the most commonly associated condition in orbital mucormycosis (Farooq et al 2015).…”

“…is facilitated by high amount serum iron and glucose (Farooq et al 2015). Uncontrolled diabetes mellitus remain the most commonly associated condition in orbital mucormycosis (Farooq et al 2015). Furthermore, acidoketosis is a favourable metabolic stat where there will be rapid growth of Mucorales (Toumi et al 2012).…”

“…In mucormycosis, amphotericin B along with aggressive surgical debridement remains the mainstay of treatment (Farooq et al 2015;Toumi et al 2012). While treating for fungal orbital cellulitis, intra-orbital catheter delivery of amphotericin B may be useful as adjunctive therapy (Farooq et al 2015). In addition to that, blood glucose control should be optimized in patients who are diabetics as uncontrolled blood sugar tends to worsen the condition.…”

A Rare Complication of Orbital Cellulitis in a Diabetic Case: Cavernous Sinus Thrombosis

“…Some infections lead a more serious course in diabetic cases and become complicated at a higher rate. [11][12][13] Preseptal (periorbital) cellulitis and orbital (post-septal) cellulitis are the 2 main orbital infections. Preseptal cellulitis is more frequent, but orbital cellulitis is more dangerous.…”