SHM Converge Scientific Abstract ePoster Gallery-Medical and Surgical Management of Extensive Rhinoorbital Cerebral Mucormycosis (Rocm)

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This case report describes the difficult diagnosis and management of extensive rhino-orbito-cerebral mucormycosis (ROCM) in a 26-year-old man with poorly controlled type 1 diabetes and diabetic ketoacidosis. He presented with right facial and orbital swelling after a broken tooth and failed outpatient amoxicillin treatment. Initial MRI showed right orbital cellulitis and invasive fungal sinusitis, prompting early antifungal therapy despite radiography often being non-diagnostic in mucormycosis.<br /><br />The patient underwent repeated bedside nasal endoscopies, which showed inflamed and necrotic sinonasal tissue. Pathology confirmed invasive mucormycosis, and cultures later grew Rhizopus species. His illness progressed from orbital involvement to cerebral disease, including cerebritis, infarcts, and abscess formation. Because disease control was extensive and source control remained difficult, he required multiple surgical debridements, irrigation of the nasal and orbital cavities with amphotericin, and ultimately right orbital exenteration.<br /><br />Treatment included liposomal amphotericin B, micafungin, and later isavuconazole. Nephrotoxicity limited amphotericin dosing, and salvage therapy with liposomal amphotericin B plus rifampin was attempted. Despite aggressive medical and surgical management, infection control could not be achieved after three months, and the patient was discharged to hospice on isavuconazole.<br /><br />The report emphasizes several key points: ROCM is a highly lethal infection, especially in immunocompromised and diabetic patients; steroid use during the COVID era has increased risk; biopsy is often required for diagnosis because molecular tests may be negative; and imaging can be crucial for early detection even when not definitive. Early suspicion, prompt antifungal therapy, and aggressive debridement are essential, but outcomes remain poor once the brain is involved.

Asset Subtitle

SangHo Jee

Meta Tag

Author List Hafiz Shabbir Patwa, Haiyan Lu, Kimberly Stogner-Underwood, Ryan Thomas Mott, SangHo Jee, Sindhuja Marupudi, Stacey Wolfe, Suneetha Kalathoor

Category Clinical Vignettes

Concept Rhino-orbital-cerebral mucormycosis

Concept Biopsy

Concept Histopathology

Concept Liposomal Amphotericin B

Concept Surgical Debridement

Distinguished Non-Finalist

Presenter Organization Wake Forest School of Medicine

Presenting Author SangHo Jee

Track Adult

Keywords

rhino-orbito-cerebral mucormycosis

ROCM

type 1 diabetes

diabetic ketoacidosis

invasive fungal sinusitis

Rhizopus species

orbital exenteration

liposomal amphotericin B

cerebral abscess

aggressive debridement

Rhino-orbital-cerebral mucormycosis

Biopsy

Histopathology

Liposomal Amphotericin B

Surgical Debridement