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Acute orbital apex syndrome and rhino-orbito-cerebral mucormycosis

Authors Anders U, Taylor E, Martel J, Martel J

Received 17 February 2015

Accepted for publication 2 March 2015

Published 17 April 2015 Volume 2015:8 Pages 93—96

DOI https://doi.org/10.2147/IMCRJ.S83036

Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 3

Editor who approved publication: Dr Scott Fraser

Ursula M Anders,1 Elise J Taylor,1 Joseph R Martel,1–3 James B Martel1–3

1Research Center, Martel Eye Medical Group, Rancho Cordova, 2Graduate Medical Education, California Northstate University College of Medicine, Elk Grove, 3Department of Ophthalmology, Dignity Health, Carmichael, CA, USA

Purpose: To demonstrate the successful clinical identification and management of rhino-orbital mucormycosis, a fungal infection with a high mortality rate.
Patients and methods: A diabetic male patient with a headache and orbital apex syndrome in the right eye was examined using computed tomography (CT) and magnetic resonance imaging (MRI) for a possible fungal infection. Endoscopic surgical resection was performed and a pathology sample was taken. Specimens were prepared with Gömöri methenamine silver and hematoxylin and eosin staining. The patient was treated with liposomal amphotericin B 400 mg daily, followed by posaconazole 400 mg twice daily.
Results: CT and MRI revealed a mass of the right sphenoid spreading into the orbit, indicative of a fungal infection. The biopsy confirmed the diagnosis of mucormycosis. Complete recovery of eyelid and oculomotor function was achieved after 10 months of treatment, although the patient continues to suffer from irreversible blindness in the right eye due to optic nerve atrophy. He has been without signs or symptoms of recurrence.
Conclusion: Patients with rhino-orbito-cerebral mucormycosis need extensive surgical and medical treatment to maximize outcomes. Success requires multidisciplinary management.

Keywords: ophthalmoplegia, sixth nerve palsy, diabetes mellitus, nephrotoxicity, amphotericin B, posaconazole

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