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Published on: March 18, 2020

Isolated orbito-cerebral mucormycosis.

Chi-Ieong Lau1, Han-Cheng Wang, Hsu-Ling Yeh

  • 1Department of Neurology, Shin Kong Wu Ho-Su Memorial Hospital.

The Neurologist
|May 3, 2011
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Summary

Rhino-orbito-cerebral mucormycosis (ROCM) is a deadly infection. Early signs like black eschars, even in the eye, are crucial for rapid diagnosis and treatment of this severe fungal disease.

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Area of Science:

  • Mycology
  • Infectious Diseases
  • Vascular Medicine

Background:

  • Rhino-orbito-cerebral mucormycosis (ROCM) is a life-threatening fungal infection predominantly affecting immunocompromised individuals.
  • Timely diagnosis of ROCM is critical to prevent treatment delays and improve patient outcomes.
  • The characteristic sign of ROCM is typically a black eschar, often found in the nasal cavity.

Observation:

  • This case highlights an unusual presentation of fulminant ROCM potentially originating from an orbital infection.
  • The patient presented with black eschars at the bilateral canthi, serving as the initial indicator of extensive vascular compromise.
  • The infection rapidly progressed, leading to occlusion of the ophthalmic arteries and major intracranial arteries.

Findings:

  • ROCM can manifest with orbital involvement without primary nasal or paranasal sinus disease.
  • Orbital black eschars can be an early warning sign of rapidly progressing, fatal ROCM.
  • Extensive vascular involvement, including ophthalmic and intracranial arteries, can occur in severe ROCM cases.

Implications:

  • This case expands the understanding of ROCM's diverse clinical presentations and routes of acquisition.
  • Ophthalmologists and infectious disease specialists should consider ROCM in cases of orbital infections with necrotic lesions.
  • Prompt recognition of atypical ROCM presentations is vital for initiating aggressive, potentially life-saving treatment strategies.