Son Jun Hyuk, Lim Hyung Bin, Lee Soo Hyun, Yang Jae Wook, Lee Sung Bok
Department of Ophthalmology, Yeungnam University College of Medicine, Daegu, Republic of Korea.
Department of Ophthalmology, Chungnam National University College of Medicine, Daejeon, Republic of Korea.
PLoS One. 2016 Aug 8;11(8):e0160897. doi: 10.1371/journal.pone.0160897. eCollection 2016.
To identify significant clinical and radiological findings that distinguish rhino-orbito-cerebral mucormycosis (ROCM) from bacterial orbital cellulitis (BOC).
This study was retrospective, multicenter, case-control study that enrolled 34 cases; 14 cases were diagnosed with ROCM and 20 cases were diagnosed with BOC at three different tertiary hospitals between 2005 and 2013. The medical records of all 34 cases were reviewed. The initial clinical manifestations (eyelid swelling, ptosis, extraocular muscle [EOM] limitation, conjunctival injection, and chemosis) and computed tomography (CT) findings (sinus mucosal thickening, full opacification, and air-fluid level) of both diseases were compared.
Patients with diabetes mellitus (DM) and hypertension (HTN) showed higher incidence rates of ROCM than BOC (DM: p < 0.001, HTN: p = 0.036). ROCM cases exhibited more frequent EOM limitation than cases with BOC (100.0% vs. 66.7%, p = 0.024) but less frequent eyelid swelling (35.7% vs. 90.0%, p = 0.002). However, the incidence rates of ptosis, conjunctival injection, and chemosis exhibited no differences between the diseases. Abnormal CT findings were observed in the sinuses of all patients with ROCM, whereas 12 patients with BOC had sinus abnormalities (100.0% vs. 60.0%, p = 0.011). Thickening of the sinus mucosa was more frequent in patients with ROCM than in those with BOC (92.9% vs. 45.0%, p = 0.009). No significant differences in full opacification or air-fluid level were detected between the groups.
The differential diagnosis of ROCM and BOC is difficult. Nevertheless, physicians should consider ROCM when a patient with suspected orbital cellulitis presents with EOM limitation without swollen eyelids or thickening of the sinus mucosa on a CT scan.
确定能将鼻眶脑型毛霉菌病（ROCM）与细菌性眼眶蜂窝织炎（BOC）区分开来的重要临床和影像学表现。
本研究为回顾性、多中心病例对照研究，纳入34例患者；2005年至2013年间，在3家不同的三级医院中，14例被诊断为ROCM，20例被诊断为BOC。对所有34例患者的病历进行了回顾。比较了两种疾病的初始临床表现（眼睑肿胀、上睑下垂、眼外肌[EOM]受限、结膜充血和球结膜水肿）和计算机断层扫描（CT）表现（鼻窦黏膜增厚、完全混浊和液气平面）。
糖尿病（DM）和高血压（HTN）患者中ROCM的发病率高于BOC（DM：p<0.001，HTN：p = 0.036）。ROCM患者比BOC患者更频繁出现EOM受限（100.0%对66.7%，p = 0.024），但眼睑肿胀频率更低（35.7%对90.0%，p = 0.002）。然而，上睑下垂、结膜充血和球结膜水肿的发病率在两种疾病之间无差异。所有ROCM患者的鼻窦均观察到CT异常表现，而12例BOC患者有鼻窦异常（100.0%对60.0%，p = 0.011）。ROCM患者鼻窦黏膜增厚比BOC患者更频繁（92.9%对45.0%，p = 0.009）。两组之间在完全混浊或液气平面方面未检测到显著差异。
ROCM和BOC的鉴别诊断具有挑战性。尽管如此，当疑似眼眶蜂窝织炎的患者出现EOM受限且CT扫描显示无眼睑肿胀或鼻窦黏膜增厚时，医生应考虑ROCM。
