title: Rhino-orbital-cerebral mucormycosis (ROCM): a comprehensive case review.
abstract: The objective of this paper is to review a recent case of rhino-orbital-cerebral mucormycosis that involved the successful treatment of an immunocompromised male patient that took place in a deployed military setting. In this interventional case review, a comprehensive evaluation of predisposing factors, presenting signs and symptoms, diagnostic evaluation, and treatment will be discussed in detail. The patient was a 38-yr-old noncompliant insulin-dependent diabetes mellitus Iraqi man whose initial presentation encompassed nonspecific signs and symptoms consistent with sinusitis. Symptoms progressed rapidly including the development of acute visual loss, unilateral facial edema, fixed dilated right pupil, loss of extraocular movements, and oropharyngeal eschar formation. With this progressive clinical picture, a diagnosis of mucormycosis was made in the absence of histological confirmation due to the nature of the deployed environment. Treatment included hospitalization for combined intervention with intravenous antifungal therapy and a series of surgeries which ultimately resulted in orbital exenteration and preservation of life. Successful treatment was attributed to having a high index of suspicion in the clinical presentation of nonspecific otorhinolaryngological and ophthalmological symptoms superimposed with underlying predisposing immunocompromised host conditions.
authors: 332nd Expeditionary Medical Group, Balad, Iraq. Mdibar79@gmail.com
authors: Michael A
authors: MA
authors: DiBartolo
authors: Patrick S
authors: PS
authors: Kelley
mesh_terms: D000328:Adult; D000666:Amphotericin B / Q000009:adverse effects / Q000627:therapeutic use; D000935:Antifungal Agents / Q000009:adverse effects / Q000627:therapeutic use; D001927:Brain Diseases / Q000382:microbiology*; D003646:Debridement; D018500:Diabetes Insipidus, Nephrogenic / Q000139:chemically induced; D003922:Diabetes Mellitus, Type 1 / Q000150:complications; D018450:Disease Progression; D015821:Eye Infections, Fungal / Q000188:drug therapy / Q000601:surgery; D006801:Humans; D016867:Immunocompromised Host; D008279:Magnetic Resonance Imaging; D008297:Male; D009091:Mucormycosis / Q000175:diagnosis / Q000188:drug therapy; D009668:Nose Diseases / Q000382:microbiology*; D009916:Orbital Diseases / Q000382:microbiology*; D014057:Tomography, X-Ray Computed; D014230:Triazoles / Q000008:administration & dosage
chemical_list: D000935:Antifungal Agents; D014230:Triazoles; C101425:posaconazole; D000666:Amphotericin B