eMedicine Specialties > Ophthalmology > Infectious Disease

Mucormycosis: Differential Diagnoses & Workup

Author: Kimberly G Yen, MD, Assistant Professor of Ophthalmology, Department of Ophthalmology, Cullen Eye Institute, Baylor College of Medicine
Coauthor(s): Michael T Yen, MD, Associate Professor of Ophthalmology, Department of Ophthalmology, Division of Ophthalmic Plastic, Lacrimal, and Orbital Surgery, Cullen Eye Institute, Baylor College of Medicine
Contributor Information and Disclosures

Updated: Dec 31, 2008

Differential Diagnoses

Cellulitis, Orbital
Cellulitis, Preseptal

Other Problems to Be Considered

Other fungal infections
Hypercoagulable states

Workup

Imaging Studies

  • Perform CT scan to evaluate soft tissue extent, mucosal thickening, bone erosion, intracranial/cavernous sinus involvement, and sinus disease. In general, bone erosion is a late finding.
  • Perform MRI to evaluate vessels, fat, and intracranial extension.

Procedures

  • Perform urgent exploration and biopsy if mucormycosis is suspected.
    • Send frozen and permanent sections and fresh tissue.
    • If clinical suspicion is high, but initial specimens are negative, take additional specimens, to include the arteries.

Histologic Findings

Necrotic and edematous tissue with neutrophilic infiltrate is seen. The fungus has broad, nonseptate hyphae with branching at 90°. Grocott-Gomori methenamine-silver stain is the best stain to use, but hematoxylin and eosin and periodic acid-Schiff also may be used. Blood vessels appear thrombosed, and hyphae may be seen invading the vessels. Growth of this fungus occurs best in brain-heart infusion agar, potato dextrose agar, or Sabouraud dextrose agar.

More on Mucormycosis

Overview: Mucormycosis
Differential Diagnoses & Workup: Mucormycosis
Treatment & Medication: Mucormycosis
Follow-up: Mucormycosis
Multimedia: Mucormycosis
References
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References

  1. Gilbard SM, Della Rocca RC. Paranasal sinus disease and the orbit. In: Nesi FA, et al, ed. Smith's Ophthalmic Plastic and Reconstructive Surgery. 2nd ed. 1998:896-930.

  2. Rocha G, Garza G, Font RL. Orbital pathology associated with diabetes mellitus. Int Ophthalmol Clin. Spring 1998;38(2):169-79. [Medline].

  3. Yohai RA, Bullock JD, Aziz AA, et al. Survival factors in rhino-orbital-cerebral mucormycosis. Surv Ophthalmol. Jul-Aug 1994;39(1):3-22. [Medline].

  4. Guevara N, Roy D, Dutruc-Rosset C, et al. Mucormycosis--early diagnosis and treatment. Rev Laryngol Otol Rhinol (Bord). 2004;125(2):127-31. [Medline].

  5. Turunc T, Demiroglu YZ, Aliskan H, et al. Eleven cases of mucormycosis with atypical clinical manifestations in diabetic patients. Diabetes Res Clin Pract. Nov 2008;82(2):203-8. [Medline].

  6. Nithyanandam S, Jacob MS, Battu RR, et al. Rhino-orbito-cerebral mucormycosis. A retrospective analysis of clinical features and treatment outcomes. Indian J Ophthalmol. Sep 2003;51(3):231-6. [Medline].

  7. Bhansali A, Sharma A, Kashyap A, et al. Mucor endophthalmitis. Acta Ophthalmol Scand. Feb 2001;79(1):88-90. [Medline].

  8. Arndt S, Aschendorff A, Echternach M, et al. Rhino-orbital-cerebral mucormycosis and aspergillosis: differential diagnosis and treatment. Eur Arch Otorhinolaryngol. Jan 2009;266(1):71-6. [Medline].

  9. Doty CI, Lucchesi M. Mucormycosis manifesting as proptosis and unilateral blindness. Acad Emerg Med. Aug 2000;7(8):944-6. [Medline].

  10. Strasser MD, Kennedy RJ, Adam RD. Rhinocerebral mucormycosis. Therapy with amphotericin B lipid complex. Arch Intern Med. Feb 12 1996;156(3):337-9. [Medline].

  11. Tarani L, Costantino F, Notheis G, et al. Long-term posaconazole treatment and follow-up of rhino-orbital-cerebral mucormycosis in a diabetic girl. Pediatr Diabetes. Sep 17 2008;[Medline].

  12. Reed C, Bryant R, Ibrahim AS, et al. Combination polyene-caspofungin treatment of rhino-orbital-cerebral mucormycosis. Clin Infect Dis. Aug 1 2008;47(3):364-71. [Medline].

  13. Luna JD, Ponssa XS, Rodriguez SD, et al. Intraconal amphotericin B for the treatment of rhino-orbital mucormycosis. Ophthalmic Surg Lasers. Aug 1996;27(8):706-8. [Medline].

  14. Seiff SR, Choo PH, Carter SR. Role of local amphotericin B therapy for sino-orbital fungal infections. Ophthal Plast Reconstr Surg. Jan 1999;15(1):28-31. [Medline].

  15. Hargrove RN, Wesley RE, Klippenstein KA, et al. Indications for orbital exenteration in mucormycosis. Ophthal Plast Reconstr Surg. Jul-Aug 2006;22(4):286-91. [Medline].

  16. Pelton RW, Peterson EA, Patel BC, et al. Successful treatment of rhino-orbital mucormycosis without exenteration: the use of multiple treatment modalities. Ophthal Plast Reconstr Surg. Jan 2001;17(1):62-6. [Medline].

  17. Hargrove RN, Wesley RE, Klippenstein KA, et al. Indications for orbital exenteration in mucormycosis. Ophthal Plast Reconstr Surg. Jul-Aug 2006;22(4):286-91. [Medline].

  18. Croce A, Moretti A, D'Agostino L, et al. Orbital exenteration in elderly patients: personal experience. Acta Otorhinolaryngol Ital. Aug 2008;28(4):193-9. [Medline].

  19. Lari AR, Kanjoor JR, Vulvoda M, et al. Orbital reconstruction following sino-nasal mucormycosis. Br J Plast Surg. Jan 2002;55(1):72-5. [Medline].

  20. Dhiwakar M, Thakar A, Bahadur S. Improving outcomes in rhinocerebral mucormycosis--early diagnostic pointers and prognostic factors. J Laryngol Otol. Nov 2003;117(11):861-5. [Medline].

  21. Fairley C, Sullivan TJ, Bartley P, et al. Survival after rhino-orbital-cerebral mucormycosis in an immunocompetent patient. Ophthalmology. Mar 2000;107(3):555-8. [Medline].

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Further Reading

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Keywords

mucormycosis , Mucor, rhinocerebral mucormycosis, rhino-orbital cerebral mucormycosis

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Contributor Information and Disclosures

Author

Kimberly G Yen, MD, Assistant Professor of Ophthalmology, Department of Ophthalmology, Cullen Eye Institute, Baylor College of Medicine
Kimberly G Yen, MD is a member of the following medical societies: Association for Research in Vision and Ophthalmology
Disclosure: Nothing to disclose.

Coauthor(s)

Michael T Yen, MD, Associate Professor of Ophthalmology, Department of Ophthalmology, Division of Ophthalmic Plastic, Lacrimal, and Orbital Surgery, Cullen Eye Institute, Baylor College of Medicine
Michael T Yen, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Cataract and Refractive Surgery, American Society of Ophthalmic Plastic and Reconstructive Surgery, and Association for Research in Vision and Ophthalmology
Disclosure: Nothing to disclose.

Medical Editor

Ron W Pelton, MD, PhD, Private Practice, Colorado Springs, Colorado
Ron W Pelton, MD, PhD is a member of the following medical societies: American Academy of Ophthalmology, American Medical Association, American Society of Ophthalmic Plastic and Reconstructive Surgery, Colorado Medical Society, Utah Medical Association, and Wilderness Medical Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Simon K Law, MD, PharmD, Assistant Professor of Ophthalmology, Jules Stein Eye Institute; Chief of Section of Ophthalmology Surgical Services, Department of Veterans Affairs Healthcare Center, West Los Angeles
Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Association for Research in Vision and Ophthalmology
Disclosure: Nothing to disclose.

Managing Editor

Mark T Duffy, MD, PhD, Consulting Staff, Division of Oculoplastic, Orbito-facial, Lacrimal and Reconstructive Surgery, Green Bay Eye Clinic, BayCare Clinic; Medical Director, Advanced Cosmetic Solutions, A BayCare Clinic
Mark T Duffy, MD, PhD is a member of the following medical societies: American Academy of Ophthalmology, American Medical Association, American Society of Ophthalmic Plastic and Reconstructive Surgery, Sigma Xi, and Society for Neuroscience
Disclosure: Allergan - Botox Cosmetic Consulting fee Consulting; Quest medical - lacrimal balloons Honoraria Speaking and teaching; Ortho-Neutrogenia Consulting fee Consulting

CME Editor

Lance L Brown, OD, MD, Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri
Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD, Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences
Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology
Disclosure: Nothing to disclose.

 
 
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