Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Correspondence
  • Published:

Intraorbital amphotericin B for mucormycosis in an Allo-HSCT recipient

Bone Marrow Transplantation (2024)Cite this article

Subjects

Mucormycosis is an aggressive angio-invasive fungal disease caused by organisms in the Mucoraceae family and Zygomycetes class; Rhizopus, Rhizomucor, and Mucor are included in this genus [1]. Mucormycosis is typically initiated by inhalation of these fungal spores and can readily disseminate into various organs through complex interactions related to their invasive hyphae. Mucormycosis orbital syndrome is a rare and unfortunate sequela of alloHSCT due to their prolonged immunosuppression resulting in cellular and humoral immune deficiency [2]. In alloHSCT, despite advances in medical treatment and surgical intervention, the disease-related mortality is approximately 75%, with a median survival of less than 2 months [3]. The standard of care treatment for these invasive fungal infections includes surgical debridement and high-dose IV liposomal amphotericin B [4, 5]. However, these interventions are limited by renal toxicity, electrolyte disturbances, and surgical disfigurement. We present a case in which we supplement standard of care treatment of orbital mucormycosis with intraorbital administration of amphotericin B with the intent to reduce systemic therapy-related toxicity and improve overall efficacy of therapy.

We present a 68-year-old patient with myelodysplastic syndrome (MDS-EB2) status-post-matched related donor alloHSCT. Despite receiving graft-versus-host disease (GVHD) prophylaxis with tacrolimus and methotrexate, his transplant course was complicated by GVHD involving the skin, liver, and mouth requiring prolonged therapeutic tacrolimus and high-dose steroids. On Day +245, our patient presented with right orbital swelling, eye pain, proptosis, decreased vision, and palsy of right cranial nerve III. Magnetic resonance imaging (MRI) of the face and orbits was consistent with a right inferomedial extraconal orbital abscess, dural thickening, and enhancement along the inferior right frontal lobe, with a high degree of concern for invasive fungal infection (IFI) of the orbit. The patient underwent right frontal sinus exploration, bilateral maxillary antrostomy, bilateral total ethmoidectomy, right sphenoidotomy, right middle turbinate resection, right orbital decompression, and drainage of an orbital abscess. A right intraorbital drain was placed to mitigate fluid collection post-operatively.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

References

  1. Vergidis P Mucormycosis. Wayne State University School of Medicine Merck.

  2. Baldin C, Ibrahim AS. Molecular mechanisms of mucormycosis: the bitter and the sweet. PLoS Pathog. 2017;13:e1006408. https://doi.org/10.1371/journal.ppat.1006408.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Mir SL, Ahmed S, Ghanghro L, Priya, Khatri G, Hasan MH. Mucormycosis infection in hematopoietic stem cell transplant patients: a serious threat. Ann Med Surg (Lond). 2022;82:104353. https://doi.org/10.1016/j.amsu.2022.104353.

    Article  PubMed  Google Scholar 

  4. Miller MA, Molina K, Gutman J, Scherger S, Lum J, Mossad SB. Mucormycosis in hematopoietic cell transplant recipients and in patients with hematological malignancies in the era of new antifungal agents. Open Forum Infect Dis. 2021;8:ofaa646.

    Article  PubMed  Google Scholar 

  5. Kontoyiannis DP, Lewis RE. How I treat mucormycosis. Blood. 2011;118:1216–24.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Nucci M, Marr KA. Emerging fungal diseases. Clin Infect Dis. 2005;41:521.

    Article  PubMed  Google Scholar 

  7. Seiff SR, Choo PH, Carter SR. Role of local amphotericin B therapy for sino-orbital fungal infections. Ophthalmic Plast Reconstr Surg. 1999;15:28–31. https://doi.org/10.1097/00002341-199901000-00007.

    Article  CAS  PubMed  Google Scholar 

  8. Joos ZP, Patel BCK. Intraorbital irrigation of amphotericin B in the treatment of rhino-orbital mucormycosis. Ophthalmic Plast Reconstr Surg. 2017;33:e13–6. https://doi.org/10.1097/IOP.0000000000000377.

    Article  PubMed  Google Scholar 

Download references

Funding

Funding

There was no specific funding for this project.

Author information

Authors and Affiliations

  1. Transplant and Cellular Therapy Program, Huntsman Cancer Institute, University of Utah, Salt Lake City, USA

    Wyatt Schwartz, Adam C. Christiansen & Sagar S. Patel

Authors
  1. Wyatt Schwartz
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Adam C. Christiansen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sagar S. Patel
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

WAS, AC, and SP helped write the manuscript.

Corresponding author

Correspondence to Wyatt Schwartz.

Ethics declarations

Consent

Consent to review this case was obtained by the patient’s next of kin.

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Schwartz, W., Christiansen, A.C. & Patel, S.S. Intraorbital amphotericin B for mucormycosis in an Allo-HSCT recipient. Bone Marrow Transplant (2024). https://doi.org/10.1038/s41409-024-02287-2

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1038/s41409-024-02287-2

Search

Advanced search

Quick links