Rhino-Orbito-Cerebral Mucormycosis: Two Cases with Amaurosis as Presentation, Medical Surgical Management and Follow-Up

Navarro-Perea, Carmen; Cañas-Zamarra, Ignacio; Mencía‐Gutiérrez, Enrique; Revilla-Sánchez, Enrique; Lago-Llinás, María-Dolores; Pérez-Trigo, Silvia; Bengoa-González, Álvaro

doi:10.1155/2019/4215989

Cited by 7 publications

(8 citation statements)

References 18 publications

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“…As reported in multiple cases, mucormycosis may affect brain vessels. In general, for central nervous system [ 36 , 37 ] involvement, imaging studies, such as CT-scans, MRI, and angiography, are recommended to rule out neurological compromise and infection, as we did for our case. Although our patient did not exhibit direct neurological affectation, he did present with a constellation of neuro-ophthalmological manifestations, including, headache, diplopia, decreased visual acuity in the right eye, and amaurosis.…”

Section: Discussionmentioning

confidence: 86%

“…This case was a 55-year-old diabetic male who complained of headache, maxillary sinus pain, and diplopia for three days, in whom mucormycosis was later confirmed [ 36 ]. Likewise, two cases were reported from Spain in 2019, both patients in their 50s, one diabetic, the other in chronic renal failure, who presented sudden unilateral amaurosis depicting an atypical presentation form of rhino-orbital-cerebral mucormycosis [ 37 ].…”

Section: Discussionmentioning

confidence: 99%

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COVID-19 Associated Rhino-Orbital Mucormycosis Complicated by Gangrenous and Bone Necrosis—A Case Report from Honduras

et al. 2021

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Background: Mucormycosis is a life-threatening invasive fungal infection most commonly observed in immunocompromised patients. Throughout the COVID-19 pandemic, a growing number of Mucorales associated infections, now termed COVID-19 associated mucormycosis (CAM), have been reported. Despite an increase in fatality reports, no cases of rhino-orbital CAM complicated with gangrenous bone necrosis have been described in the literature to date. Case: A 56-year-old male with a recent COVID-19 diagnosis developed rhino-orbital mucormycosis after 22 days of treatment with dexamethasone. Cultures and histopathological assessment of tissue biopsy confirmed the diagnosis. The patient survived after treatment with amphotericin B. Conclusions: Mucormycosis is an invasive fungal infection affecting mostly immunocompromised patients. Along with the COVID-19 pandemic, the inappropriate use of steroids, in addition to concurrent risk factors, such as diabetes, has led to an increase in the occurrence of these devastating mycoses, leading to the development of severe presentations and complications, as observed in many cases. Early diagnosis and prompt treatment are crucial in order to avoid dissemination and fatal outcomes.

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Section: Discussionmentioning

confidence: 86%

Section: Discussionmentioning

confidence: 99%

COVID-19 Associated Rhino-Orbital Mucormycosis Complicated by Gangrenous and Bone Necrosis—A Case Report from Honduras

et al. 2021

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“…For example, Vironneau et al (2014) showed a statistically significant difference in mortality between patients who received topical therapy or without. Navarro-Perea et al (2019) presented a case of improvement with surgery combined with local therapy and emphasized the importance of topical management. Joos and Patel (2017) also proposed conservative orbital debridement with local antifungal irrigation is a viable option as well.…”

Section: Discussionmentioning

confidence: 99%

Fungal Endophthalmitis in a Case of Rhino-Orbito-Cerebral Mucormycosis: Successfully Treated With Amphotericin B Colloidal Dispersion

Zhao

Yang

et al. 2022

Front. Microbiol.

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BackgroundRhino-orbito-cerebral mucormycosis (ROCM) is an acute, fulminant, opportunistic fungal infection that usually occurs in diabetes or immunocompromised patients. Amphotericin B combined with surgical debridement remains the standard treatment, although it is controversial due to its lager nephrotoxicity. Thus far, no studies have reported the treatment for ROCM-associated fungal endophthalmitis because the exact pathogenesis and transmission routes in ROCM remain unclear. Here, we reported a case of ROCM complicated with fungal endophthalmitis treated favorably with amphotericin B colloidal dispersion (ABCD) in combination with other antifungals and surgical debridement.Case PresentationA 34-year-old woman with diabetes was admitted to our hospital owing to right-sided headache for 8 days, blindness with swelling in the right eye for 5 days, and blindness in the left eye for 1 day. MRI showed that the patient had sphenoid sinus, sinuses, frontal lobe lesions, and proptosis of the right eye. Metagenomic sequencing revealed that the patient had Rhizopus oryzae infection. During hospitalization, the patient received intravenous ABCD, oral posaconazole, and topical amphotericin B and underwent surgical debridement. After 67 days of treatment, the patient’s condition was significantly improved, and limb muscle strength showed grade V. Rhizopus oryzae showed negative results, and conjunctival swelling decreased. Additionally, no nephrotoxicity occurred during treatment. After discharge, the patient’s treatment was transitioned to oral posaconazole and she was free of complaints during the 30-day follow-up without any additional treatment for ROCM.ConclusionTreatment with ABCD combined with other antifungal drugs and surgical debridement for ROCM complicated with fungal endophthalmitis showed remarkable efficacy and good safety. Hence, this regimen is a promising treatment strategy for this fatal disease.

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“…It occurs predominantly in immunocompromised individuals or patients with co-morbid conditions though cases are also reported in healthy individuals. [ 1 2 ] The risk factors attributing to the development of mucormycosis are diabetes mellitus (especially uncontrolled diabetes like diabetic ketoacidosis), solid organ transplantation, neutropenia, long-term systemic corticosteroid use, and any other etiology causing immunosuppression. [ 3 4 ]…”

Section: Introductionmentioning

confidence: 99%

“…Mucormycosis can manifest in many different clinical forms, including rhino-orbito-cerebral (ROC), pulmonary, cutaneous, gastrointestinal, disseminated, and other unusual presentations. [ 1 ] Out of these rhino-orbital-cerebral-mucormycosis (ROCM) is the most common form of mucormycosis which occurs as a result of inhalation of the fungal spores by the host leading to rapidly progressive disease. It disseminates from the sino-nasal tissues to the involvement of orbits and finally the central nervous system.…”

Section: Introductionmentioning

confidence: 99%

Spectrum of magnetic resonance imaging findings in post-COVID-19 patients presenting with rhino-orbito-cerebral mucormycosis in a teaching hospital in Malwa region of Punjab

Kaur

Singh

Kaur

et al. 2022

Journal of Family Medicine and Primary Care

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A BSTRACT Background: Rhino-orbito-cerebral-mucormycosis (ROCM) associated with COVID-19 infection was at its peak during and immediately after the second wave of the pandemic in India during 2021. Many of the risk factors were implicated in the development of this deadly fungal infection, when there was a sudden surge of cases, especially who had a history of COVID-19 infection. Objectives: The objective of the study was to describe the characteristic magnetic resonance imaging (MRI) findings in invasive mucormycosis and to evaluate the extent and severity of invasive mucormycosis. Materials and Methods: A retrospective study was carried out for 4 months which included 60 patients who underwent MRI using a Siemens Avanto 1.5 Tesla scanner. During our study, 68 cases were selected based on clinicoradiological features suspected of ROCM. However, 8 patients were excluded on the basis of exclusion criteria as either there was no definitive evidence of COVID infection or were proven to be negative for mucormycosis on microbiological examination. Results: On the basis of the spectrum of MRI findings, post-COVID-19 related ROCM was broadly categorized into three stages. Out of total of 60 patients, the disease was localized to the nasal and paranasal sinus region (Stage I) in 7 patients (11.66%), extending to adjacent extrasinus orofacial soft tissue structures (Stage II) in 36 patients (60%), and intracranial extension of disease (Stage III) was seen in 17 patients (28.33%). Conclusion: In post-COVID-19 patients presenting with clinical features suspected of ROCM, MRI imaging helps in early diagnosis and staging/severity of ROCM, so that timely intervention can be planned to reduce mortality as well as morbidity.

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Rhino-Orbito-Cerebral Mucormycosis: Two Cases with Amaurosis as Presentation, Medical Surgical Management and Follow-Up

Cited by 7 publications

References 18 publications

COVID-19 Associated Rhino-Orbital Mucormycosis Complicated by Gangrenous and Bone Necrosis—A Case Report from Honduras

COVID-19 Associated Rhino-Orbital Mucormycosis Complicated by Gangrenous and Bone Necrosis—A Case Report from Honduras

Fungal Endophthalmitis in a Case of Rhino-Orbito-Cerebral Mucormycosis: Successfully Treated With Amphotericin B Colloidal Dispersion

Spectrum of magnetic resonance imaging findings in post-COVID-19 patients presenting with rhino-orbito-cerebral mucormycosis in a teaching hospital in Malwa region of Punjab

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