Rhino-orbital Mucormycosis Treated Successfully with Posaconazole without Exenteration.
Mucormycosis is a rare and often fatal opportunistic angioinvasive infection seen mostly in immunocompromised patients, such as those with diabetes mellitus, cancer, or renal failure. Ophthalmic manifestations of orbital mucormycosis include ocular pain, periocular oedema, visual loss, ophthalmoplegia, proptosis, and ptosis. Although therapy for orbital mucormycosis consists of maximally tolerated doses of antifungal agents (e.g., amphotericin B) and extensive surgical debridement, treatment remains ineffective in up to 20% of cases. We describe two patients with rhino-orbitalmucormycosis who were successfully treated with posaconazole in conjunction with intravenous (IV) amphotericin B and sinus surgical debridement. These cases highlight several unusual early manifestations of orbital mucormycosis, including disc oedema and amaurosis fugax, as well as the applicability of a new extended-spectrum antifungal agent in management of orbital zygomycosis.
Department of Ophthalmology, The Methodist Hospital, HoustonTexasUSA; Baylor College of Medicine, HoustonTexasUSA.
Jason
J
Zhang
Department of Ophthalmology, The Methodist Hospital, HoustonTexasUSA; Department of Ophthalmology, The University of Texas Medical Branch, GalvestonTexasUSA.
James D
JD
Kim
Department of Ophthalmology, The Methodist Hospital, Houston Texas USA.
Hilary A
HA
Beaver
Baylor College of Medicine, Houston Texas USA.
Masayoshi
M
Takashima
Department of Ophthalmology, The Methodist Hospital, HoustonTexasUSA; Baylor College of Medicine, HoustonTexasUSA; Departments of Ophthalmology, Neurology, and Neurosurgery, Weill Cornell Medical College, New YorkNew YorkUSA; Department of Ophthalmology, The University of Texas Medical Branch, GalvestonTexasUSA; Department of Ophthalmology, The University of Iowa Hospitals and Clinics, Iowa CityIowaUSA.
Andrew G
AG
Lee
Disc oedema; mucormycosis; orbital apex syndrome; posaconazole; rhino-orbital