| Successful Treatment of Rhino-Orbital Mucormycosis with Posaconazole after Combination of Surgical Treatment and Amphotericin B. |
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Byung Moon Kim, Keun Hae Kim |
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Department of Ophthalmology, Catholic University of Daegu School of Medicine, Daegu, Korea. kimkh@cu.ac.kr |
| 수술적 치료와 암포테리신 병용요법 후 포사코나졸로 완치된 비안와형 뮤코르진균증 |
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김병문⋅김근해 |
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대구가톨릭대학교 의과대학 안과학교실 |
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Received: 26 February 2015 • Revised: 7 May 2015 • Accepted: 12 May 2015 |
| Abstract |
PURPOSE
To report a case of rhino-orbital mucormycosis successfully treated by posaconazole salvage therapy after a surgical intervention combined with amphotericin B treatment. CASE SUMMARY: A 57-year-old female with uncontrolled diabetes mellitus presented to our department with left periorbital swelling and pain for 3 days. At initial presentation, complete ptosis, complete external ophthalmoplegia, and exophthalmos of 6 mm were observed in the left eye. Pupillary reflex was absent in the left eye. Orbital magnetic resonance imaging showed left focal maxillary sinusitis and left posterior orbital inflammatory infiltration with left optic nerve involvement. Nasal endoscopic examination showed black eschar in both nasal cavities. Histopathological examination of the involved nasal cavities showed non-septated fungal hyphae with blunt-angle branching, thus rhino-orbital mucormycosis was diagnosed. The patient underwent a lid-sparing subtotal exenteration, wide endonasal debridement of the nasal necrotic tissues, and intravenous injections of amphotericin B for 7 weeks. The patient continued to receive oral posaconazole salvage therapy for 6 months and was successfully treated. At the 44-month follow-up, recurrence was not observed, and the patient is wearing a new type of silicone oculofacial prosthesis. CONCLUSIONS: Rhino-orbital mucormycosis is an aggressive, opportunistic fungal infection that is life-threatening despite exenteration and amphotericin B treatment. Sequential use of oral posaconazole as salvage therapy may be helpful for a successful treatment. |
| Key Words:
Mucormycosis;Oculofacial prosthesis;Posaconazole;Salvage therapy |
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