[A suspected case of orbital mucormycosis]

This is a report on a case of suspected orbital mucormycosis after hematological examination, for whom local administration of antifungal drugs was markedly effective.

A 65-year-old male developing phlegmon of the left orbit was seen at our clinic. Computed tomography revealed increased density of soft tissues and swollen external rectus muscle without any shadow of a tumor mass. The lesion was not responsive to the drip infusion of imipenem, or to oral administration of nonsteroid preparations, or to instillation of antibacterial drugs. Serum IgE levels were high, and it was suspected that the patient had orbital mycosis. After switching medication to fluconazole, injection and edema of the bulbar conjunctiva worsened, and a cable-shaped mass was palpable in the inferior margin of the orbit. Later, serum Mucor IgE antibody was found to be positive, so the patient was suspected to have mucormycosis. Medication was changed to a frequent instillation of Amphotericin B. Since edema of the bulbar conjunctiva improved, injection of the same drug under the Tenon's capsule was also given. One month after the hospital stay, the inflammatory findings of the left eye disappeared with a decrease in serum IgE levels and serum Mucor antibody.

In cases where orbital mucormycosis is suspected, cure may be expected even by the local administration of Amphotericin B if the inflammation is localized in the anterior part of the orbit. In this disease, it is possible that examination of serum IgE and serum Mucor IgE antibody is useful for diagnosis and assessment of the clinical effects.