A report of successfully treated rhino-orbital mucormycosis

Vincent Prasanna, Beulah Edwin, Shanthi Banukumar, Elango Dhanapal


Rhino-cerebral mucormycosis is a rare life-threatening infection caused by fungi from the order Mucorales. The disease occurs mostly in association with diabetic ketoacidosis. Because of its rapid progression and high mortality, early recognition and aggressive treatment offer the only chance to increase the survival rate. We report a case of invasive mucormycosis in a 55 year old diabetic male, who presented with diabetic ketoacidosis and sinusitis. The patient came with complaints of swelling in right side of face, pain in right eye, right orbital swelling and numbness right cheek. An ENT examination revealed right facial swelling and proptosis. Nasal swabs were sent to microbiology for fungal culture. Material from the swab was inoculated on Sabaraud’s dextrose agar and incubated at 37°C and 25°C. The culture was identified as mucor species. Material sent for histopathology showed presence of chronic inflammatory polyp with broad aseptate hyphae suggestive of mucormycosis. On the third day, bilateral middle meatal antrostomy, bilateral anterior and posterior ethmoidectomy and bilateral wide sphenoidotomy was done. Fungal debris were noticed in both maxillary antrum. In the post-operative period, patient was started on inj. amphotericin B. On the 11th post-operative day, patient developed palatal mucosal necrosis. Under general anaesthesia, extensive surgical 2nd look and debridement was done. The necrotic palatal mucosa was completely removed. In addition to IV amphotericin B, topical douching of both nasal cavities and antrum with amphotericin B was done for 20 days. Patient improved, became completely asymptomatic and was discharged.



Rhino-orbital mucormycosis, Diabetic ketoacidosis, Intranasal amphotericin B, Orbital decompression, Proptosis

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Ferry AP, Abedi S. Diagnosis and management of rhino-orbitocerebral mucormycosis (phycomycosis). A report of 16 personally observed cases. Ophthalmol. 1983;90(9):1096-1104.

Hadzri MH, Azarisman SM, Fauzi AR, Kahairi A. Invasive rhino-cerebral mucormycosis with orbital extension in poorly-controlled diabetes. Singapore Med J. 2009 Mar;50(3):e107-9.

Prabhu RM, Patel R. Mucormycosis and entomophthoramycosis: a review of the clinical manifestations, diagnosis and treatment. Clin Microbiol Infect. 2004;10(Suppl. 1):31-47.

Haliloglu NU, Yesilirmak Z, Erden A, Erden I. Rhino-orbito-cerebral mucormycosis: report of two cases and review of the literature. Dentomaxill Radiol. 2008;37:161-6.

Bhansali A, Bhadada S, Sharma A, Suresh V, Gupta A, Singh P, Chakarbarti A, Dash RJ. Presentation and outcome of rhino-orbital-cerebral mucormycosis in patients with diabetes. Postgrad Med J. 2004;80:670-4.

Orsel S, Bessède JP, Sauvage JP. Naso-orbito-cerebral mucormycosis. A more & more common disease. Rev Laryngol Otol Rhinol (Bord). 1990;111(3):221-5.

Nithyanandam S, Jacob MS, Battu RR, Thomas RK, Correa MA, D'Souza O. Rhino-orbito-cerebral Mucormycosis. A retrospective analysis of clinical features and treatment outcomes. Indian J Ophthalmol. 2003;51:231-6.

Groll AH, Gea-Banacloche JC, Glasmacher A, Just-Nuebling G, Maschmeyer G, Walsh TJ. Clinical pharmacology of antifungal compounds. Infect Dis Clin North Am. 2003;17(1):159-91.

Ponikau JU, Sherris DA, Weaver A, Kita H. Treatment of chronic rhinosinusitis with intranasal amphotericin B: a randomized, placebo-controlled, double-blind pilot trial. J Allergy Clin Immunol. 2005;115(1):125-31.

Ricchetti A, Landis BN, Maffioli A, Giger R, Zeng C, Lacroix JS. Effect of anti-fungal nasal lavage with amphotericin B on nasal polyposis. J Laryngol Otol. 2002;116(4):261-3.