Dr. SIDDHARTH MADAN

Prof.Dr. JOLLY ROHATGI, Dr.Pramod Kumar Sahu, Dr.PRIYANKA GAUTAM

Abstract

Rhino-orbito-cerebral mucormycosis necessitates prompt management with intravenous (IV) amphotericin B and sinonasal debridement with or without orbital exenteration. A 33-year-old male with type 2 DM developed rhino-orbital mucormycosis with CRAO OD and had normal ocular motility. He underwent endoscopic sinonasal debridement and received 8000 mg of amphotericin B over 1.5 months. Surprisingly he deteriorated demonstrating total ophthalmoplegia, lid edema and complete ptosis OD. Nasal endoscopy was inconclusive. CE-MRI showed worsening with involvement of orbital apex, extraconal and intraconal space. Decision to perform a mutilating surgery as orbital exenteration was challenging. However pulse dexamethasone therapy initiated for 3 days with tapering dose of oral steroids for 2 weeks and response was rewarding. Ophthalmoplegia recovered significantly, ptosis and lid edema reduced. Currently he is oral Posaconazole (300 mg daily) with over 1.5 months of follow-up and doing well.