1/20. Lung cancer, proptosis, and decreased vision.A 48-year-old man presented to the emergency department with a 3-day history of decreased vision in a painful proptotic right eye. The patient was being treated with chemotherapy and radiation for non-small cell lung carcinoma. Examination showed visual acuity of hand motions, decreased motility, and an afferent pupillary defect on the right, consistent with an orbital apex syndrome. neuroimaging revealed "dirty" orbital fat and no paranasal sinus disease. Orbital biopsy initially showed only fibrosis; however, on subsequent biopsies, nonseptate hyphae later identified as mucormycosis was recovered. The patient survived with exenteration and systemic amphotericin b.- - - - - - - - - - ranking = 1keywords = mucormycosis (Clic here for more details about this article) |
2/20. survival after rhino-orbital-cerebral mucormycosis in an immunocompetent patient.OBJECTIVE: Rhino-orbital-cerebral mucormycosis is usually associated with a poor prognosis and is almost exclusively seen in immunocompromised patients. We report the third documented case of rhino-orbital-cerebral mucormycosis caused by Apophysomyces elegans (a new genus of the family Mucoraceae first isolated in 1979) in an immunocompetent individual. Orbital exenteration and radical debridement of involved adjacent structures combined with intravenous liposomal amphotericin resulted in patient survival. DESIGN: Interventional case report. METHOD: A 59-year-old immunocompetent white man sustained a high-pressure water jet injury to the right inner canthus while cleaning an air conditioner filter. He later had "orbital cellulitis" develop that did not respond to antibiotics and progressed to orbital infarction. Imaging studies and biopsy results led to a diagnosis of mucormycosis. Tissue culture grew Apophysomyces elegans, a new genus of the family Mucoraceae first isolated in 1979. Orbital exenteration and radical debridement of involved adjacent structures, combined with intravenous liposomal amphotericin, resulted in patient survival. RESULTS: After orbital exenteration and debridement of involved adjacent structures along with intravenous liposomal amphotericin, our patient has remained free from relapse with long-term follow-up. CONCLUSIONS: The agent causing this case of rhino-orbital-cerebral mucormycosis (Apophysomyces elegans) contrasts with the three genera most commonly responsible for mucormycosis (rhizopus, Mucor, and absidia) in that infections with this agent tend to occur in warm climates, by means of traumatic inoculation, and in immunocompetent patients. Rhino-orbital-cerebral mucormycosis should be considered in all patients with orbital inflammation associated with multiple cranial nerve palsies and retinal or orbital infarction, regardless of their immunologic status. A team approach to management is recommended for early, appropriate surgery and systemic antifungal agents.- - - - - - - - - - ranking = 10keywords = mucormycosis (Clic here for more details about this article) |
3/20. Mucor endophthalmitis.PURPOSE: To report on a case of type 2 diabetes, with eyelid gangrene and endophthalmitis as a presenting manifestation of rhino-orbito-cerebral mucormycosis. RESULTS: CECT head showed proptosis, mucosal thickening in the ethmoid sinus and hypodense lesions in the frontal and occipital lobes. Vitreous tap showed right angle branched aseptate hyphae consistent with mucormycosis. CONCLUSIONS: A diabetic patient presenting with sudden loss of vision, eyelid gangrene and endophthalmitis, involvement by an angio-invasive fungus-like mucormycosis is an important consideration.- - - - - - - - - - ranking = 3keywords = mucormycosis (Clic here for more details about this article) |
4/20. Successful treatment of rhino-orbital mucormycosis without exenteration: the use of multiple treatment modalities.PURPOSE: To describe the successful management of rhino-orbital mucormycosis without the use of orbital exenteration. METHOD: Case report. RESULTS: The patient had successful eradication of the fungal infection with retention of normal vision and ocular function. CONCLUSIONS: The use of multiple treatment modalities including aggressive surgical debridement guided by intraoperative frozen section monitoring, intravenous liposomal amphotericin b, intraorbital regular amphotericin b and hyperbaric oxygen may allow complete resolution of orbital phycomycosis and spare the patient from the blindness and disfigurement associated with exenteration.- - - - - - - - - - ranking = 5keywords = mucormycosis (Clic here for more details about this article) |
5/20. Serous retinal detachment in a patient with rhino-orbital mucormycosis.BACKGROUND: Rhino-orbital mucormycosis is a difficult disease to treat. We report one case of rhino-orbital mucormycosis, complicated by serous retinal detachment, that responded to aggressive treatment. CASE: A 38-year-old man with diabetic ketoacidosis was referred to the emergency department of our hospital with fever, proptotic right eye, and complaint of lethargy. OBSERVATIONS: Fundus examination showed serous retinal detachment and focal lesions of retinitis with exudate at the inferior portion coincident with the position of opacification in the orbit on MRI. fluorescein angiography showed pooling of dye in the detached retina and leakage from focal lesions of retinitis. We thoroughly removed the large necrotic materials in the orbit and sinus through the lower conjunctiva without enucleation or exenteration. Microscopic examination and culture of the necrotic materials that were removed from the orbit proved that the patient had mucormycosis. The serous retinal detachment improved 10 days after orbital debridement combined with intravenous and local (intraorbital) amphotericin b treatment. visual acuity recovered to 20/50. CONCLUSION: We propose that inflammation of the sclera in close contact with necrotic fungi materials may cause serous retinal detachment.- - - - - - - - - - ranking = 7keywords = mucormycosis (Clic here for more details about this article) |
6/20. Rhino-orbital mucormycosis in a patient with acquired immunodeficiency syndrome (AIDS) and neutropenia.PURPOSE: To present a case of rhino-orbital mucormycosis in a patient with AIDS and neutropenia managed without exenteration. methods: Case report. RESULTS: A 60-year-old African-American man with AIDS developed neutropenia that was probably secondary to antiretroviral therapy. He developed right rhino-orbital mucormycosis and was treated with right partial ethmoidectomy with debridement and liposomal amphotericin b. The infection was cured without need for orbital exenteration, although visual acuity in his right eye ultimately was no light perception. CONCLUSION: Rhino-orbital mucormycosis is uncommon in patients with AIDS. When rhino-orbital mucormycosis occurs, patients require a careful search for an underlying metabolic derangement such as neutropenia. Treatment should be aggressive, but these patients may not require orbital exenteration.- - - - - - - - - - ranking = 8keywords = mucormycosis (Clic here for more details about this article) |
7/20. Indolent orbital apex syndrome caused by occult mucormycosis.The chronic or indolent presentation of rhino-orbital mucormycosis, as defined by the presence of symptoms for more than 1 month before diagnosis, is extremely unusual. A 45-year-old man with stable diabetes presented with a right orbital apex syndrome and minimal ethmoid and sphenoid sinusitis. Progression was indolent, and the diagnosis was not made until 7 weeks after admission, when a third biopsy was prompted by new cavernous sinus and carotid artery thromboses. mucormycosis was found. The patient improved on amphotericin b (2 g) and strict blood glucose control. A remarkable aberrant regeneration of the right oculomotor nerve was seen following treatment. He remains free of active disease 4 years later. Orbital symptoms in well-controlled diabetics, which may even remain stable for weeks and lack direct signs of tissue invasion, should raise the suspicion of mucormycosis.- - - - - - - - - - ranking = 6keywords = mucormycosis (Clic here for more details about this article) |
8/20. Ocular invasion in mucormycosis.The histopathologic findings in a case of ocular invasion in rhinocerebral mucormycosis are described. The findings of hyphae in the inner sclera and marked involvement of the posterior ciliary arteries suggested an arterial route of ocular invasion by fungus. Only five other cases of rhinocerebral mucormycosis with ocular fungal invasion have been reported to our knowledge. All six patients died from the infection. As a group, these cases suggest that the presence of ocular infiltration by fungus may indicate poor prognosis in rhinocerebral mucormycosis.- - - - - - - - - - ranking = 7keywords = mucormycosis (Clic here for more details about this article) |
9/20. Adjunctive hyperbaric oxygen in the treatment of bilateral cerebro-rhino-orbital mucormycosis.survival is uncommon in bilateral cerebro-rhino-orbital mucormycosis treated surgically and medically. A 66-year-old man in previously good health had bilateral cerebro-rhino-orbital mucormycosis and newly diagnosed nonketotic diabetes mellitus at initial examination. Total loss of vision, proptosis, and ophthalmoplegia of both eyes were present. The patient was treated with aggressive surgical and medical therapies that included bilateral orbital exenteration, intravenous and local amphotericin b, hyperbaric oxygen, and control of the diabetes mellitus. One and one-half years after onset of the illness, the patient is alert and clinically stable. The importance of prompt diagnosis and aggressive treatment of this disease is emphasized by this case. Additionally, we suggest that adjunctive hyperbaric oxygen is a reasonable modality in the treatment of this often fatal disease.- - - - - - - - - - ranking = 6keywords = mucormycosis (Clic here for more details about this article) |
10/20. Rhino-orbito-cerebral mucormycosis: a treatment dilemma.A case of rhino-orbito-cerebral mucormycosis is presented showing its aggressive nature and progression of disease. The typical clinical features, neuroimaging and histological findings are highlighted in this report. amphotericin b and surgical debridement remain the mainstay of treatment. However, associated co-morbidities need to be addressed.- - - - - - - - - - ranking = 5keywords = mucormycosis (Clic here for more details about this article) |
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