1/64. Endoscopic sinus surgery in the management of mucormycosis.This is a report of the use of endoscopic sinus surgery in the management of three patients diagnosed with rhino-orbital or rhino-orbito-cerebral mucormycosis. A retrospective review was performed of the clinical examinations and imaging studies of three patients who underwent endoscopic sinus surgery as part of their therapy for mucormycosis. In addition to endoscopic surgery, all patients had aggressive control of underlying risk factors (diabetes mellitus, immunosuppression) and prolonged intravenous amphotericin b therapy. All three patients survived and avoided orbital exenteration. In selected patients with rhino-orbito-cerebral mucormycosis, endoscopic techniques can play a valuable role in diagnosis and management.- - - - - - - - - - ranking = 1keywords = mucormycosis (Clic here for more details about this article) |
2/64. 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 = 0.14285714285714keywords = mucormycosis (Clic here for more details about this article) |
3/64. Rhinosino-orbital mucormycosis causing cavernous sinus thrombosis and internal carotid artery occlusion: radiological findings in a patient with treatment failure.The authors describe a case of rhinosino-orbital mucormycosis with cavernous sinus thrombosis in association with internal carotid artery occlusion diagnosed by use of computerized tomography (CT) and magnetic resonance imaging (MRI). Cranial CT is a useful imaging tool in the diagnosis of rhinosinal invasive fungal disease and MRI offers excellent aid in the detection of intracranial extension. early diagnosis and rapid institution of surgical debridement and antifungal therapy is the rule of thumb in treating this disorder. In our patient, surgically inaccessible bone lesion and involvement of the central nervous system are taken as major causes for his grave outcome. In addition, failure to advance appropriate amphotericin b dosage may also make the infectious process uncontrollable in this patient.- - - - - - - - - - ranking = 0.71428571428571keywords = mucormycosis (Clic here for more details about this article) |
4/64. 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 = 1.4285714285714keywords = mucormycosis (Clic here for more details about this article) |
5/64. Craniofacial mucormycosis following assault: an unusual presentation of an unusual disease.A case of craniofacial mucormycosis following assault is discussed. A female diabetic developed peri-orbital cellulitis adjacent to a scalp wound which progressed to a necrotizing fasciitis. This did not respond to treatment. Subsequently the patient developed a hemiparesis, with CT imaging showing peri-orbital and paranasal sinus inflammatory changes, evidence of cavernous sinus invasion and development of a middle cerebral artery territory infarction. The patient died shortly afterwards. The imaging findings and their relationship to the pathological spread of mucor infection are discussed.- - - - - - - - - - ranking = 0.71428571428571keywords = mucormycosis (Clic here for more details about this article) |
6/64. 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 = 0.42857142857143keywords = mucormycosis (Clic here for more details about this article) |
7/64. 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 = 0.71428571428571keywords = mucormycosis (Clic here for more details about this article) |
8/64. Rhinocerebral zygomycosis in a patient with acute lymphoblastic leukemia.We report a case of a 28-year-old man with acute lymphoblastic leukemia who developed rhinocerebral zygomycosis during induction chemotherapy. This life-threatening fungal infection is an infrequent cause of neutropenic fever, and is occasionally found in patients with leukemia and lymphoma, or patients with severely compromised defence mechanisms due to other diseases. It is caused by moulds belonging to the Mucoraceae family, and is characterized by local destruction of the affected organ. In our patient, the infection spread from the paranasal sinuses to the right orbit, destroyed intraorbital structures and resulted in blindness within days. biopsy from the right maxillary sinus was performed and mucormycosis was suspected through microscopic examination. culture of the resected specimen identified rhizopus arrhizus as the causing agent. Treatment of zygomycosis should consist of radical surgical debridement of the infected tissue, together with intensive broad-spectrum antimycotic therapy with amphotericin b. What could be learned from this case is, that aggressive approaches to identify the cause of infection is necessary, and that aggressive treatment strategies are inevitable to overcome the infection. Furthermore, treatment of the underlying disease should be continued as soon as possible.- - - - - - - - - - ranking = 0.14285714285714keywords = mucormycosis (Clic here for more details about this article) |
9/64. Orbital inflammation in a patient with extrascleral spread of choroidal malignant melanoma.An elderly woman presented with fever, dehydration, orbital inflammation, total external and internal ophthalmoplegia and blindness, resembling the clinical appearance at presentation of severe orbital inflammatory disease or mucormycosis. Orbital computed tomography scanning demonstrated a retrobulbar orbital mass. Subsequent B-scan ultrasound examination confirmed the orbital mass but also demonstrated a mass within the eye. At lateral orbitotomy, extrascleral spread of an entirely necrotic intraocular melanoma was demonstrated. As computed tomography scanning may not be able to delineate an entirely necrotic intraocular malignant melanoma, B-scan ultrasonography should be considered in patients with orbital inflammation, especially in the presence of a retrobulbar mass.- - - - - - - - - - ranking = 0.14285714285714keywords = mucormycosis (Clic here for more details about this article) |
10/64. 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 = 1keywords = mucormycosis (Clic here for more details about this article) |
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