Survival after rhino-orbital-cerebral mucormycosis in an immunocompetent patient

Objective: Rhino-orbital-cerebral mucormycosis is usually associated with a poor prognosis and is almost exclusively seen in immunocompromised patient s. We report the third documented case of rhino-orbital-cerebral mucormycos is caused by Apophysomyces elegans (a new genus of the family Mucoraceae fi rst isolated in 1979) in an immunocompetent individual. Orbital exenteratio n and radical debridement of involved adjacent structures combined with int ravenous liposomal amphotericin resulted in patient survival. Design: interventional case report. Methods A 59-year-old immunocompetent white man sustained a high-pressure w ater jet injury to the right inner canthus while cleaning an air conditione r filter. He later had "orbital cellulitis" develop that did not respond to antibiotics and progressed to orbital infarction, Imaging studies and biop sy results led to a diagnosis of mucormycosis, Tissue culture grew Apophyso myces elegans, a new genus of the family Mucoraceae first isolated in 1979, Orbital exenteration and radical debridement of involved adjacent structur es, combined with intravenous liposomal amphotericin, resulted in patient s urvival. Results: After orbital exenteration and debridement of involved adjacent st ructures along with intravenous liposomal amphotericin, our patient has rem ained free from relapse with long-term follow-up. Conclusions: The agent causing this case of rhino-orbital-cerebral mucormyc osis (Apophysomyces elegans) contrasts with the three genera most commonly responsible for mucormycosis (Rhizopus, Mucor, and Absidia) in that infecti ons with this agent tend to occur in warm climates, by means of traumatic i noculation, and in immunocompetent patients. Rhino-orbital-cerebral mucormy cosis should be considered in all patients with orbital inflammation associ ated with multiple cranial nerve palsies and retinal or orbital infarction, regardless of their immunologic status. A team approach to management is r ecommended for early, appropriate surgery and systemic antifungal agents. ( C) 2000 by the American Academy of Ophthalmology.