Sinoorbital mucormycosis due to Apophysomyces elegans in immunocompetent individuals--an increasing trend.

OBJECTIVE

Mucormycosis is a fatal infection of the immunocompromised individuals. Apophysomyces elegans is an unusual pathogen causing mucormycosis. It is unusual to affect the healthy individuals. We report 5 such cases of infection caused by A elegans in immunocompetent individuals.

STUDY

DESIGN

Retrospective case review conducted at a tertiary referral center.

METHODS

From 1999 to 2004, 5 cases of mucormycosis caused by A elegans were managed in otherwise healthy patients. All of them were treated with surgery. Clinical presentation, imaging studies, mycological findings, operative findings at surgery, and postoperative results were evaluated. A review of literature about mucormycosis caused by A elegans infecting otherwise healthy patients in orbit, nose, and paranasal sinuses has been done.

RESULTS

All had no previous history of trauma or any invasive procedure. All of them underwent surgical treatment. Histopathological examination showed broad, sparsely aseptate, thin-walled hyphae and angioinvasion with thrombosis. Fungal culture revealed A elegans.

CONCLUSION

Mucormycosis must be considered in the differential diagnosis of any severe acute headache, sinusitis, or orbital cellulites not only in the immunocompromised patients but also in the absence of any underlying disease. Successful treatment requires early debridement and systemic antifungal treatment with injection of amphotericin B.