ABSIDIAL RHINO-ORBITAL MUCORMYCOSIS COMPLICATING THE MANAGEMENT OF OCULAR TRAUMA

Absidia are rare causes of rhino-orbital mucormycosis, which is genera lly associated with Rhizopus infection. A 61-year-old man sustained oc ular trauma to his left eye. His traumatic optic neuropathy was treate d with high-dose corticosteroids and with optic nerve sheath and optic nerve canal decompressions. A retinal dialysis was also corrected sur gically. Two weeks later, the patient developed an orbital cellulitis with extensive upper eyelid necrosis. Biopsies revealed necrotic tissu es on two occasions. Absidia and Peptostreptococcus were isolated from both specimens. Combined intensive amphotericin B and antibacterial t herapy and two extensive surgical debridements successfully treated th e polymicrobial mucormycosis, allowing eventual skin-graft repair. Int ensive corticosteroid use appeared to be the principal inducing factor in thin case, compounded by surgery involving the sinuses. The pathog enesis appeared entirely iatrogenic, complicating the management of oc ular trauma. The characteristic constellation of signs and rapid disea se progression were absent in this case, but this may reflect the absi dial etiologic agent. Mucormycosis diagnosis requires special biopsy p reparation. With early diagnosis and intensive medical and surgical th erapy, the prognosis of rhino-orbital (and rhinocerebral) mucormycosis continues to improve.