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Rhino-orbito-cerebral mucormycosis following penetrating keratoplasty
1Department of Ophthalmology, King Abdulaziz University Hospital, Jeddah, Saudi Arabia.
Abstract:
Rhino-orbito-cerebral mucormycosis (ROCM) is a potentially devastating fungal infection with a significant fatality rate. Early diagnosis and prompt management are crucial to ensure a favorable outcome due to the recognized rapid progression. This case is a rare presentation of ROCM in a patient with uncontrolled diabetes following a corneal transplant. The procedure required early surgical resection in the first 30 hours of hospitalization. The patient received wide-spectrum antibiotics and antifungal treatment and underwent extensive debridement of the necrotic area. A high index of suspicion is needed to diagnose ROCM. Any diabetic patient with sinonasal disease and/or cranial nerve involvement, irrespective of their serum glucose or glycated hemoglobin levels, is a candidate for prompt evaluation to exclude mucormycosis. The rapid evolution of our case highlights the importance of treating ROCM promptly and aggressively.
Insights
Rhino-orbito-cerebral mucormycosis (ROCM) is a rare but deadly fungal infection. Prompt diagnosis and aggressive treatment, including surgery, are vital for survival, especially in diabetic patients.
Area of Science:
- Mycology
- Infectious Diseases
- Ophthalmology
Background:
- Rhino-orbito-cerebral mucormycosis (ROCM) is a severe fungal infection with high mortality.
- Rapid progression necessitates early diagnosis and intervention for better outcomes.
Observation:
- A rare case of ROCM presented in a patient with uncontrolled diabetes post-corneal transplant.
- The patient required surgical resection within 30 hours of admission.
Findings:
- Aggressive management included wide-spectrum antibiotics, antifungal therapy, and extensive debridement.
- Prompt surgical intervention and medical treatment were crucial for this patient's outcome.
Implications:
- Highlights the need for a high index of suspicion for ROCM in diabetic patients with sinonasal or cranial nerve issues.
- Emphasizes the importance of prompt and aggressive treatment strategies for ROCM, regardless of glycemic control.
- Underscores the critical role of early evaluation and intervention in managing this devastating infection.
