Use of topical amphotericin in a case of refractory sino-orbital angioinvasive mucormycosis

Abstract

The standard of care for treatment of sino-orbital mucormycosis involves aggressive surgical debridement and liposomal amphotericin, and the roles of adjunctive and topical therapies are less clear. Here we describe a case of severe refractory sino-orbital mucormycosis in an immunocompetent patient who responded to combination therapy with liposomal amphotericin, isavuconazole, micafungin, and topical amphotericin deoxycholate after failing to achieve negative surgical margins.

Epidemic of COVID-Associated Mucormycosis in India and a road ahead

“…One of the strategies is to use a higher dosage (10 mg/Kg) of amphotericin-B in invasive intracranial mucormycosis by intravenous route of administration (24). Anecdotal reports suggest adjuvant use of intraocular topical instillation of amphotericin in sino-orbital mucormycosis to achieve disease-free status in a post-surgical group after exenteration of orbit (25,26). This finding may be extrapolated for use of topical nasal drops after an ENT surgery.…”

Rhino-orbital mucormycosis

“…However, TRAMB can lead to inflammation, edema, and compartment syndrome, possibly making it difficult to differentiate postinjection inflammation from disease progression [27 ▪ ]. Another study even highlights the use of topical AMB as an adjunct therapy for refractory mucormycosis with improvements even after orbital exenteration [32]. Intravitreal AMB may be useful in patients with endophthalmitis [11].…”

“…]. Another study even highlights the use of topical AMB as an adjunct therapy for refractory mucormycosis with improvements even after orbital exenteration [32]. Intravitreal AMB may be useful in patients with endophthalmitis [11].…”