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Clinical, Radiological, and Histopathological Findings of Post-Exenterated Mucormycosis Specimens
Vidhyadevi Ramasamy1, Shiguru Saudhamini1, Sakhtisankari Shanmugasundaram1
1Department of Ophthalmology and Pathology, PSGIMSR, Coimbatore, India.
Introduction:
A sharp upsurge in the number of coronavirus disease-associated mucormycosis cases was noted during the second wave of coronavirus disease in India. The fungal hyphae spread from the nasal mucosa, orbit to the brain, hence otherwise called rhino-orbito-cerebral mucormycosis (ROCM). Prompt diagnosis and early initiation of treatment with amphotericin B, aggressive surgical debridement of the PNS, and orbital exenteration, where indicated, are essential for successful outcome. This study is done to enumerate the clinical, radiological, and histopathological findings of post-exenterated specimens of ROCM.
Methods:
This is a non-randomized cross-sectional study conducted at a tertiary care center. Ten post-exenterated specimens were examined histopathologically for the involvement of the central retinal artery, superior ophthalmic vein (SOV), optic nerve, muscle, and orbital fat showing necrosis.Clinical findings of these 10 patients were studied retrospectively for visual loss, proptosis, extraocular movements for muscle involvement, scleral necrosis, and fundus findings for artery or vein occlusions. Preoperative magnetic resonance imaging (MRI) findings like the number of orbital quadrants showing soft tissue thickening or tissue enhancement, diffusion restriction in the optic nerve, soft tissue enhancement seen at the orbital apex or superior orbital fissure, loss of flow void in the left internal carotid artery, enlargement of the SOV containing filling defect on post-contrast images were noted.
Results:
Optic nerve involvement was seen in 100% patients clinically, 70% on MRI, and 50% on histopathological examination (HPE). Muscle involvement was seen in 100% patients clinically, 90% on MRI, and 80% on HPE. None of the patients had scleral necrosis clinically. Scleral tenting was seen in 20% patients on MRI and 20% on HPE. Clinically, central retinal artery involvement was seen in 40%, and cilioretinal artery involvement was seen in 10%. MRI could not give much information on artery involvement. Clinically, none of them had central retinal vein occlusion. 20% had an enlarged SOV seen on MRI. HPE showed vascular involvement in 90% of the specimens.
Conclusion:
Clinical, radiological, and histopathological findings play a major role in the diagnosis, staging, and follow-up of ROCM.
Insights
Rhino-orbito-cerebral mucormycosis (ROCM) involves the optic nerve and muscles in all patients, with vascular involvement seen in 90% of cases. Comprehensive clinical, radiological, and histopathological findings are crucial for diagnosing and managing ROCM.
Area of Science:
- Ophthalmology
- Infectious Diseases
- Radiology
Background:
- A significant increase in coronavirus disease-associated mucormycosis cases, particularly rhino-orbito-cerebral mucormycosis (ROCM), was observed in India during the second wave of the pandemic.
- ROCM is a severe fungal infection that can rapidly spread from the nasal mucosa to the orbit and brain.
Purpose of the Study:
- To analyze the clinical, radiological, and histopathological findings in post-exenterated specimens of patients with ROCM.
- To correlate these findings with disease progression and outcomes.
Main Methods:
- A cross-sectional study involving 10 patients with ROCM who underwent orbital exenteration.
- Retrospective analysis of clinical data, including visual loss and proptosis.
- Preoperative MRI evaluation for orbital soft tissue involvement, optic nerve, and vascular structures.
- Histopathological examination of post-exenterated orbital specimens to assess the extent of fungal invasion.
Main Results:
- Optic nerve and muscle involvement were present in 100% of patients clinically.
- Histopathological examination revealed vascular involvement in 90% of specimens.
- MRI showed high rates of muscle involvement (90%) and optic nerve involvement (70%), while clinical and histopathological findings varied for specific structures.
Conclusions:
- Clinical, radiological (MRI), and histopathological examinations are essential for the accurate diagnosis, staging, and monitoring of ROCM.
- Early diagnosis and prompt treatment, including surgical intervention, are critical for successful outcomes in ROCM patients.
