Transcutaneous retrobulbar amphotericin B for rhino-orbital-cerebral mucormycosis: a multi-center retrospective comparative study

Dallalzadeh, Liane O.; Ediriwickrema, Lilangi S.; Fung, Sammie E; Men, Clara J; Kossler, Andrea L; Kupcha, Anna C.; Mawn, Louise A.; Burkat, Cat N.; Landingham, Suzanne W. van; Conger, Jordan R; Simmons, Brittany A.; Pham, Chau; Akella, Suresh; Setabutr, Pete; Ho, Tiffany C.; Couch, Steven M.; Kim, Jane S.; Demirci, Hakan; Korn, Bobby S.; Kikkawa, Don O.; Liu, Catherine Y.

doi:10.1080/01676830.2023.2186435

Cited by 6 publications

(2 citation statements)

References 42 publications

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“…Resection of cavernous sinus, ICA, skull base and even dura and brain tissue is technically possible [ 16 ], and certainly necessary for limiting the disease [ 7 ], but entail considerable perioperative risk and need to be discussed thoroughly. The therapy of choice is 5–10 mg/kg/day liposomal amphotericin B. Retrobulbar injection of amphotericin B can reduce infective activity within the orbit [ 17 ]. There is no satisfactory literature on the long-term management and treatment of ROCM survivors.…”

Section: Discussionmentioning

confidence: 99%

Survival from rhino-orbital-cerebral mucormycosis in SARS-COV-2 positive diabetic patients: Two case reports

Lädrach,

Wartenberg,

Zimmerli

et al. 2024

Case Rep Neurol

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Introduction Rhino-orbital-cerebral mucormycosis (ROCM) is a rare angioinvasive fungal infection known to be associated with high morbidity and over 50% mortality. ROCM is becoming more common due to an increase in predisposing immunocompromising comorbidities as well as COVID-19. Case Presentations We report two cases – a 75-year-old woman with diabetes and a 39-year-old man with recurrent diabetic ketoacidosis. Both presented initially with acute sinonasal symptoms, were positive for SARS-CoV-2, and diagnosed with acute ROCM. Both underwent mutilating surgical therapy as well as high-dose amphotericin B treatment. With continued oral antifungal treatment, Patient 1 showed stable symptoms despite radiographically increasing disease and died of urosepsis 5 months after first surgery. With posaconazole treatment, Patient 2 recovered from the disease and showed no clinical sign of disease progression after 1 year. Conclusion Despite the rarity of the disease, ROCM should be considered if the findings of clinical and radiological examination fit, so that a delay in treatment initiation can be avoided. As our both cases show, survival from ROCM is possible – albeit at a high cost.

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Section: Discussionmentioning

confidence: 99%

Survival from rhino-orbital-cerebral mucormycosis in SARS-COV-2 positive diabetic patients: Two case reports

Lädrach,

Wartenberg,

Zimmerli

et al. 2024

Case Rep Neurol

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“…were reported. Exenteration was necessary in only very few patients reported to have been treated with local AmB as a result [11][12][13][14][15]. Compared with free AmB, application of liposomal AmB results in greater corneal tissue concentration and less ocular toxicity [16].…”

Section: Case Reports In Ophthalmologymentioning

confidence: 99%

Survival of a Rhino-Orbital-Cerebral Mucormycosis Patient after Localized Combination Liposomal Amphotericin B Medications: A Case Report

Zhou

2024

Case Rep Ophthalmol

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Introduction: The aim of this study was to report a case of ROCM related to nasogastric intubation who was survived by liposomal amphotericin B (LAmB) combination therapy in situ without orbital exenteration. Case Presentation: A 44-year-old woman presented with a 1-week history of rapidly enlarging swelling on the right nose, cheek, and lower eyelid after underwent gastrointestinal decompression. The lesions were derived from the nasal area where the nasogastric tube had been placed. Based on the biopsy results and clinical manifestations, ROCM was diagnosed. Immediate combination therapy with intravenous LAmB and micafungin and multisection debridement of the right facial region were applied. Postoperative treatment included cleaning, irrigating, and local dressing of the wound area using LAmB. LAmB was also used daily as binocular eye drops against deep infection on the eyeballs. The patient recovered well 4 months later and remained free of disease after 40 months of follow-up. Conclusion: This case adds to our knowledge on the potential risk of nasogastric intubation for mucormycosis infection. Nasogastric tube may be the source of infection associated with ROCM. This report evaluates the beneficial effect of LAmB combination therapy in situ for cleaning, irrigating, local wound dressing, and eye drops on lesion areas. The combination of LAmB as cleaning, irrigating, local dressing solution, and eye drops to control intraocular and intraorbital ROCM infection has not been previously reported to our knowledge. These methods provide multiple choices to substitute for orbital exenteration on the survival of ROCM patients.

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Unusual orbital mucormycosis due to pecking injury: clinical characteristics and outcomes of four immunocompetent pediatric patients

Rajabi,

Sadeghi,

Soltani Shahgoli

et al. 2023

Orbit

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Transcutaneous retrobulbar amphotericin B for rhino-orbital-cerebral mucormycosis: a multi-center retrospective comparative study

Cited by 6 publications

References 42 publications

Survival from rhino-orbital-cerebral mucormycosis in SARS-COV-2 positive diabetic patients: Two case reports

Survival from rhino-orbital-cerebral mucormycosis in SARS-COV-2 positive diabetic patients: Two case reports

Survival of a Rhino-Orbital-Cerebral Mucormycosis Patient after Localized Combination Liposomal Amphotericin B Medications: A Case Report

Unusual orbital mucormycosis due to pecking injury: clinical characteristics and outcomes of four immunocompetent pediatric patients

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