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Rhino-orbito-cerebral mucormycosis: recovery against the odds.

Authors
  • Zafar, Saman1
  • Prabhu, Aparna1
  • 1 Department of Neurology, Einstein Medical Center Philadelphia, Philadelphia, Pennsylvania, USA.
Type
Published Article
Journal
Practical neurology
Publication Date
Dec 01, 2017
Volume
17
Issue
6
Pages
485–488
Identifiers
DOI: 10.1136/practneurol-2017-001671
PMID: 28844040
Source
Medline
Keywords
License
Unknown

Abstract

A 22-year-old woman presented with diabetic ketoacidosis, acute right eye blindness and complete ophthalmoplegia. Despite early suspicion and treatment for rhino-orbito-cerebral mucormycosis, her extensive spread of infection led to right internal carotid artery occlusion and cavernous sinus thrombosis, right-sided cerebral watershed infarctions and large abscesses in her right cerebellum, temporal lobe and pons. She underwent surgical removal of her right eye, paranasal sinuses, maxilla and palate, suboccipital craniectomy and shunting for hydrocephalus. Despite the grave prognosis, she has gradually improved and has remained on antifungal treatment for the 18 months since presentation. We discuss the factors that may have influenced her recovery. The case highlights the aggressive nature of rhino-orbito-cerebral mucormycosis, the need for multiple surgeries and the ethical issues in managing such patients.

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