VISUAL OUTCOME WITH A MULTIMODALITY APPROACH IN A CASE OF RHINOORBITO- CEREBRAL MUCORMYCOSIS
St John's Medical College Hospital, Bangalore , India. E-mail: dr.ankita@hotmail.com
*Correspondence
Grant support: None
Conflict of Interest: None
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 multi-modality 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
Keywords: Mucormycosis, Uncontrolled diabetes, Posaconazole, Amphotericin B, Good outcome, India.