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Rhinoorbital mucormycosis in the immunocompetent: Experience with Isavuconazole
Marta Ilharco1, Carla Maravilha Pereira1, Laura Moreira1
1Department of Internal Medicine 1.4, Hospital de S. José - Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal.
Abstract:
Mucormycosis is a severe opportunistic fungal infection caused by Mucorales. The majority of the affected patients have a history of immunosuppression, with a reported incidence of 4-19% in the immunocompetent. Early recognition and diagnosis, combined with surgical debridement and appropriate antifungal therapy are essential to achieve a cure. In this article we report the case of a 61-year-old immunocompetent male who complained with pain in his right eye. After being first diagnosed with conjunctivitis and treated accordingly, he eventually needed surgical debridement and the biopsy showed the presence of fungi of the class Zygomycetes. He was submitted to intravenous therapy with Liposomal Amphotericin B (LAmB) and Posaconazole for several days, which was then changed to Isavuconazole due to bicytopenia. He also received treatment with hyperbaric oxygen, achieving altogether good results. He was discharged after eight months, still on oral Isavuconazole 200mg/day and re-evaluated after three and six months, showing no evidence of progression of the infection.
Insights
This case study highlights a rare instance of mucormycosis in an immunocompetent individual. Prompt diagnosis and multi-modal treatment, including surgery and antifungals, led to a successful recovery.
Area of Science:
- Mycology
- Infectious Diseases
- Ophthalmology
Background:
- Mucormycosis is a severe fungal infection caused by Mucorales, often associated with immunosuppression.
- While rare, mucormycosis can affect immunocompetent individuals, presenting diagnostic challenges.
Observation:
- A 61-year-old immunocompetent male presented with ocular pain, initially misdiagnosed as conjunctivitis.
- Fungal elements of Zygomycetes were identified in a biopsy after surgical debridement.
Findings:
- The patient received a combination therapy including Liposomal Amphotericin B (LAmB), Posaconazole, and later Isavuconazole due to bicytopenia.
- Hyperbaric oxygen therapy was also administered, contributing to positive outcomes.
Implications:
- This case underscores the importance of considering mucormycosis in immunocompetent patients with severe ocular infections.
- Successful management involved a multidisciplinary approach combining surgical intervention, targeted antifungal therapy, and adjunctive treatments like hyperbaric oxygen.
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