Jiang Nan, Zhao Guiqiu, Yang Shanshan, Lin Jing, Hu Liting, Che Chengye, Wang Qian, Xu Qiang
Department of Ophthalmology, the Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China.
BMC Ophthalmol. 2016 Jan 12;16:10. doi: 10.1186/s12886-016-0189-1.
Rhino-orbito-cerebral mucormycosis(ROCM) is an invasive fungal infection that usually occurs in immunocompromised patients and sometimes presents as orbital apex syndrome(OAS) initially. It is rapidly fatal without an early diagnosis and treatment. We report the cases of invasive ROCM presenting with OAS initially in order to raise the attention of clinicians.
We retrospectively investigated eleven cases of invasive ROCM presenting initially with OAS admitted between January 2006 and December 2013. We analyzed clinical features, results of laboratory and radiological examinations, nasal endoscopy, aggressive surgical excision and debridement, and medical management outcomes of each case.
A total of eleven cases of invasive ROCM with OAS as an initial sign were presented. Mucormycosis was accompanied by type II diabetes mellitus in nine cases, renal transplant in one case, and injury caused by traffic accident in one case. Anterior rhinoscopy revealed palatine or nasal necrotic lesions in all patients, and transethmoidal optic nerve decompression was carried out in three patients at the same time. CT scan revealed rhino-orbital-cerebral involvement in every patient. All patients were given intravenous amphotericin B. Nine patients underwent surgical debridement of necrotic tissue. Three patients survived.
ROCM is a severe, emergent and fatal infection requiring multidisciplinary management. It may often present with OAS initially. For ophthalmologist, mucormycosis must be considered in immunocompromised patients presenting with OAS initially, and anterior rhinoscopy is imperative before hormonotherapy, even in the cases absent of ketoacidosis induced by diabetes mellitus.
鼻眶脑毛霉菌病(ROCM)是一种侵袭性真菌感染,通常发生在免疫功能低下的患者中,有时最初表现为眶尖综合征(OAS)。如不及早诊断和治疗,该病会迅速致命。我们报告最初表现为OAS的侵袭性ROCM病例,以引起临床医生的重视。
我们回顾性调查了2006年1月至2013年12月期间收治的11例最初表现为OAS的侵袭性ROCM病例。我们分析了每个病例的临床特征、实验室和影像学检查结果、鼻内镜检查、积极的手术切除和清创以及药物治疗结果。
共呈现11例以OAS为初始体征的侵袭性ROCM病例。毛霉菌病合并II型糖尿病9例,肾移植1例,交通事故致伤1例。前鼻镜检查显示所有患者均有腭部或鼻腔坏死性病变,3例患者同时进行了经筛窦视神经减压术。CT扫描显示每位患者均有鼻眶脑受累。所有患者均接受了静脉注射两性霉素B治疗。9例患者接受了坏死组织的手术清创。3例患者存活。
ROCM是一种严重、紧急且致命的感染,需要多学科管理。它最初可能常表现为OAS。对于眼科医生而言,对于最初表现为OAS的免疫功能低下患者,必须考虑毛霉菌病,即使在没有糖尿病诱发的酮症酸中毒的情况下,在激素治疗前也必须进行前鼻镜检查。