Background and Importance Mucormycosis is a serious fungal infection that causes fast invasion, especially in immunocompromised people.
Rhino-orbital cerebral involvement manifests with oedema, sinusitis, periorbital cellulitis and others.
Treatment often requires combined endovenous and topical therapy, and depending on the involvement, surgery.
Aim and Objectives Explaining the therapeutic approach and evolution of a very severe lesion with deep necrosis in the right nostril, with rapid progression and infected by Acinetobacter Baumanii extremely multidrug-resistant (ABXDR), Aspergillus niger and Rhizopus arizus.
Material and Methods A 13-year-old patient (45kg) with Atypical Haemolytic Uremic Syndrome, admitted in another centre where she started treatment with eculizumab and receive corticotherapy, was transferred to our centre due to clinical worsening.
Presented a rapidly progression lesion with deep necrosis in the right nostril.
Wound culture isolated Acinetobacter Baumanii extremely multidrug-resistant (ABXDR) and Aspergillus Niger. Subsequently, Rhizopus arizus was isolated in the biopsy and a diagnosis of rhino-orbital mucormycosis was made. Furthermore, ABXDR is isolated in conjunctival swab and tracheal aspirate.
Systemic treatment was started with isavuconazole (loading dose: 200mg/8h for 2 days and maintenance with 200mg/24h, plasmatic levels 3.85µg/mL), liposomal amphotericin-B (225 mg/24h), meropenem 2g/8h given as a 4-hour extended infusion and nebulised colistin 2MUI every 8 h.
Locally, the wound was first surgically debrided in two steps and targeted therapy was initiated. Due to the lack of commercially available formulations, sterile gels of amphotericin B deoxycholate 0.15% and colistin 0.5% were prepared by the pharmacy service; both were prepared on a water-soluble basis. They were applied every 4 hours alternately.
During admission, topical dressings with sodium hypochlorite fomentation (MicrodacynR) plus bacteriostatic gel-based mesh (Cutimed SorbactR) were performed every 24h.
A pharmacy-prepared colistin 0.2%/6h ophthalmic gel was applied to the eyes.
Throughout the hospitalisation, the wound was closely monitored performing smears to detect the microbial growth.
Results Clinical Outcomes were a rapid wound reduction with 80% granulation and negative microbial cultures after 28 days of continuous treatment. After a month, the patient was discharged from the unit.
Conclusion and Relevance Rhino-orbital mucormycosis is a very serious condition that requires specific targeted treatment and the nursing care, surgery and pharmacy involvement as a team is essential.
Conflict of Interest No conflict of interest
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