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A. Varshney, A. Song; Rhinocerebral Mucormycosis in Southern California . Invest. Ophthalmol. Vis. Sci. 2006;47(13):292.
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To evaluate the clinical characteristics and the management of rhino–orbito–cerebral mucormycosis.
We conducted a retrospective chart review of patients with rhinocerebral mucormycosis evaluated at a tertiary care center from 2000 to 2005.
A total of 9 patients were admitted with mucormycosis. Underlying conditions predisposing to rhino–orbito–cerebral mucormycosis included uncontrolled diabetes mellitus (5), immunosuppression after chemotherapy (2), immunosuppression from prednisone intake for systemic lupus erythematosus (1), and both uncontrolled diabetes mellitus and status post liver transplant (1). Patients were diagnosed based on clinical presentation. Confirmatory biopsy of the sinuses was performed in all 9 patients. One patient was initially diagnosed with biopsy after anterior orbitotomy. Six patients required orbital exenteration and maxillectomy. Two patients did well with sinus debridement and medical management including intravenous amphotericin B, intranasal amphotericin B irrigation, and hyperbaric oxygen. Exenteration was not required in these 2 patients. One patient with extensive mucormycosis and disseminated tuberculosis died shortly after diagnosis.
Mucormycosis is an extremely fulminant infection which has been successfully treated with aggressive systemic antifungal therapy, control of underlying predisposing factors, and radical surgical debridement. In early cases, mucormycosis may be treated successfully using multimodality treatment without the need for exenteration.
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