Successful therapy of progressive rhino-orbital mucormycosis caused by Rhizopus arrhizus with combined and sequential antifungal therapy, surgery and hyperbaric therapy

Adrián Imbernón; José Luis Agud; María Soledad Cuétara; José Carlos Casqueiro; Pilar Nuñez; Alegría R Domínguez; Eusebio Bullido; Alberto M Stchigel

doi:10.1016/j.mmcr.2014.09.004

Successful therapy of progressive rhino-orbital mucormycosis caused by Rhizopus arrhizus with combined and sequential antifungal therapy, surgery and hyperbaric therapy

Med Mycol Case Rep. 2014 Oct 5:6:51-4. doi: 10.1016/j.mmcr.2014.09.004. eCollection 2014 Oct.

Authors

Adrián Imbernón¹, José Luis Agud², María Soledad Cuétara³, José Carlos Casqueiro⁴, Pilar Nuñez⁵, Alegría R Domínguez⁶, Eusebio Bullido⁷, Alberto M Stchigel⁸

Affiliations

¹ Dermatology Department, Hospital Severo Ochoa, Avenida Orellana, 28911 Leganés, Madrid, Spain.
² Internal Medicine Department, Hospital Severo Ochoa, Avenida Orellana, 28911 Leganés, Madrid, Spain.
³ Microbiology Department, Hospital Severo Ochoa, Avenida Orellana, 28911 Leganés, Madrid, Spain.
⁴ Otolaryngology Department, Hospital Severo Ochoa, Avenida Orellana, 28911 Leganés, Madrid, Spain.
⁵ Radiology Department, Hospital Severo Ochoa, Avenida Orellana, 28911 Leganés, Madrid, Spain.
⁶ Internal Medicine Department, Hospital Central de la Defensa, Glorieta del Ejército 1, 28047 Madrid, Spain.
⁷ Otolaryngology Department, Hospital Central de la Defensa, Glorieta del Ejército 1, 28047 Madrid, Spain.
⁸ Unitat de Microbiología, Facultat de Medicina I Ciencies de la Salut, Universitat Rovira I Virgili, Reus, Spain.

Abstract

We present a case of rhino-orbitary mucormycosis which progressed despite liposomal amphotericin and early surgical debridement. Combined echinocandin and high dose liposomal amphotericin, repeated debridement, prolonged therapy with hyperbaric oxygen and continued therapy with posaconazole, along with strict diabetic control, allowed cure without disfigurement.

Keywords: Amphotericin B; Diabetes mellitus; Hyperbaric oxygen; Posazonale; Rhizopus arrhizu; Zygomycosis.