VISUAL OUTCOME WITH A MULTIMODALITY APPROACH IN A CASE OF RHINOORBITO- CEREBRAL MUCORMYCOSIS
*Kothari AC, Shroff S
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ABSTRACT
Background: Rhinoorbito-cerebral mucormycosis is an uncommon and acute fungal infection which runs a fulminant course. Uncontrolled diabetes mellitus is the most common predisposing factor.
Aim: To assess the outcome of a poorly controlled diabetic with Rhinoorbito-cerebral mucormycosis using a multimodality management.
Methodology: We report a case of a 57-year old male who presented to us with proptosis and total external ophthalmoplegia diagnosed with rhino-orbito-cerebral mucormycosis. Patient was started on conventional intravenous amphotericin B to which he developed systemic toxicity. As an alternative, a combination therapy of oral posacanazole along with peribulbar amphotericin B injections for a more localised effect was initiated.
Results: He had a favourable outcome with dramatic improvement in vision and marginal recovery of extra ocular movements within 20 days of initiation of combination therapy.
Conclusion: Rhinoorbito-cerebral mucormycosis is a major diagnostic dilemma with quick progression and a high mortality. Prompt medical management with a multi-modality approach can save the patient from orbital exenteration
Key Words: Mucormycosis, Uncontrolled diabetes, Posaconazole, Amphotericin B, Good outcome, India.
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