Rhino-Orbital Cerebral Mucormycosis (ROCM): Effective Management with Liposomal Amphotericin B

Rhino-Orbital Cerebral Mucormycosis (ROCM) is a serious and often life-threatening fungal infection. The fungi class called zygomycetes are responsible for causing rhino-orbital mucormycosis which usually affects diabetic or immunocompromised patients. Infections of the nasal mucosa and paranasal sinuses occur in Stage I of ROCM, orbital involvement occurs in Stage II, and brain involvement occurs in Stage III, which mostly affects individuals with immunological or metabolic problems. Face discomfort and paraesthesia, headaches, enlarged orbits and nostrils, inflammation, drooping eyelids, proptosis, external and internal ophthalmoplegia, vision loss, and blackish necrosis of the palate and nasal mucosa are all symptoms of rhino-orbito-cerebral mucormycosis. Here we report a case of Rhino orbital cerebral mucormycosis in a 49-year-old male presented to an otorhinolaryngology department with at least 10days of retro-orbital pain and headache for, bilateral nasal obstruction, right sided facial pain and swelling and drooping of right eyelids and loss of vision in right eye from 5 days. The patient was diagnosed with invasive fungal sinusitis and underwent skull base surgery a week before admission for liposomal amphotericin-B infusion. The patient had medical history of type II diabetes mellitus and hypertension for 8 years, acute ischemic stroke recently. The patient had a history of covid 19 and was hospitalised for 25 days. The standard treatment for mucormycosis was initiated with Liposomal Amphotericin B (50 mg) Intravenous infusion-5 doses were given along with nasal packing every alternate day. Total cumulative dose of Amphotericin B-1500 mg was given. Early treatment and prompt treatment with Amphotericin B is necessary for avoiding devastating consequences.