title: VISUAL OUTCOME WITH A MULTIMODALITY APPROACH IN A CASE OF RHINOORBITO- CEREBRAL MUCORMYCOSIS.
abstract: BACKGROUND
  Rhinoorbito-cerebral mucormycosis is an uncommon and acute fungal infection which runs a fulminant course. Uncontrolled diabetes mellitus is the most common predisposing factor.
  
  
  OBJECTIVE
  To assess the outcome of a poorly controlled diabetic with Rhinoorbito-cerebral mucormycosis using a multi-modality management.
  
  
  METHODS
  We report a case of a 57-year old male who presented to us with proptosis and total external ophthalmoplegia diagnosed with rhino-orbito-cerebral mucormycosis. Patient was started on conventional intravenous amphotericin B to which he developed systemic toxicity. As an alternative, a combination therapy of oral posacanazole along with peribulbar amphotericin B injections for a more localised effect was initiated.
  
  
  RESULTS
  He had a favourable outcome with dramatic improvement in vision and marginal recovery of extra ocular movements within 20 days of initiation of combination therapy.
  
  
  CONCLUSIONS
  Rhinoorbito-cerebral mucormycosis is a major diagnostic dilemma with quick progression and a high mortality. Prompt medical management with a multi-modality approach can save the patient from orbital exenteration.
authors.affiliation: St John's Medical College Hospital, Bangalore , India.
authors.forename: A C
authors.initials: AC
authors.lastname: Kothari
authors.affiliation: St John's Medical College Hospital, Bangalore , India.
authors.forename: S
authors.initials: S
authors.lastname: Shroff
keywords: Amphotericin B; Good outcome; India; Mucormycosis; Posaconazole; Uncontrolled diabetes