Rhino-orbital fungal infection mimicking orbital malignancy – is traditional herbal preparation a predisposing factor?: Report of two cases

Authors

  • Bonsaana GB
  • Muonir Der E
  • Akorli E

Keywords:

Rhino-orbito-cerebral, Fungal infection, Recurrence, Traditional herbal preparation, Ghana

Abstract

Background: Chronic inflammatory reactions may present clinically as a neoplastic lesion. In both
immunocompromised and immunocompetent patients with orbital pathology, fungal infection should be
considered when the presenting features are unusual or patient is not responding to standard therapy. The
prognosis for sight and even life may be dire if not managed properly.
Case presentations: We report two cases of fungal infections with clinical characteristics similar to orbital
malignancy. Both patients reported the use of plant based herbal medication as eye, ear and/or nose drops for
minor ailments. The first case was a 32-year old female who presented with a two-year history of superior-medial
painless orbital swelling associated with proptosis. The second case was a 36-year old man who presented
with a one-year history of painless inferior-medial orbital mass. Head and orbit CT scans with contrast showed
features consistent with an orbital malignancy in both patients. Incisional biopsy reported fungal infection and
fungal staining revealed hyphae in both patients. Determining the specific fungal agent was a challenge as
the specimens were solid masses and paraffin-embedded blocks were prepared, unlike a wet mount in which
septated or non-septated hyphae could aid in this differentiation. Immunohistochemistry was not done due to
limited resources.
Conclusion: Rhino-orbito-cerebral fungal infection can present with features masquerading an orbital
malignancy or orbital inflammatory disease. Traditional herbal preparations for common ailments of the eye,
ear and nose may be a predisposing factor. Debulking surgery and oral antifungals may be considered in the
management of rhino-orbital fungal infection in a resource poor setting.

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References

Mukherjee B, Raichura N, Alam M. Fungal

infections of the orbit. Indian J Ophthalmol.

; 64(5):337. doi:10.4103/0301-4738.185588

Hamed-Azzam S, AlHashash I, Briscoe D, Rose

GE, Verity DH. Rare orbital infections - state

of the art - part II. J Ophthalmic Vis Res. 2018;

(2):183-190. doi:10.4103/jovr.jovr

Gamaletsou MN, Sipsas N V, Roilides E, Walsh

TJ. Rhino-orbital-cerebral mucormycosis.

SpringerLink. 2012; 14(4):423-434.

Mody KH, Ali MJ, Vemuganti GK, Nalamada

S, Naik MN, Honavar SG. Orbital aspergillosis

in immunocompetent patients. Br J Ophthalmol.

; 98(10):1379-1384. doi:10.1136/bjophthalmol

- 2013-303763.

Gumral R, Yildizoglu U, Saracli MA, Kaptan

K, Tosun F, Yildiran ST. A case of rhinoorbital

mucormycosis in a leukemic patient with a

literature review from Turkey. Mycopathologia.

; 172(5):397-405. doi:10.1007/s11046-011-

-z.

July 2020 Journal of Ophthalmology of Eastern Central and Southern Africa

Nithyanandam S, Jacob MS, Battu RR,

Thomas RK, Correa MA, D’Souza O. Rhinoorbito-

cerebral mucormycosis. A retrospective

analysis of clinical features and treatment

outcomes. Indian J Ophthalmol. 2003;

(3): 231-236. http://ovidsp.ovid.com/

ovidweb.cgi? T=JS&PAGE =reference&D

=emed6&NEWS=N&AN=2003407321.

Ebeigbe JA. Traditional eye medicine practice

in Benin-City, Nigeria. S Afr Optom. 2013;

(4):167-172.

Nyenze E, Ilako D, Karimurio J. KAP of

traditional healers on treatment of eye diseases

in Kitui district of Kenya. East Afr J Ophthalmol.

; 13:6-11.

Athavale DD, Jones R, O’Donnell BA, Forer M,

Biggs N. Non-exenteration management of sinoorbital

fungal disease. Ophthal Plast Reconstr

Surg. 2017; 33(6):426-429. doi:10.1097/

IOP.0000000000000812

Reed C, Bryant R, Ibrahim AS, Edwards J

Jr., Filler SG, Goldberg R, et al. Combination

polyene caspofung in treatment of rhino orbital

cerebral mucormycosis. Clin Infect Dis. 2008;

:364-371.

Yohai RA, Bullock JD, Aziz AA MR. Survival

factors in rhino orbital cerebral mucormycosis.

Surv Ophthalmol. 1994; 39:3-22.

Johnson T. Fungal disease of the orbit. Ophthalmol

Clin North Am. 2000; 13:643-656.

Chamilos G, Lewis RE KD. Delaying amphotericin

B based frontline therapy significantly increases

mortality among patients with hematologic

malignancy who have zygomycosis. Clin Infect

Dis. 2008; 47:503-509.

Mody KH, Ali MJ, Vemuganti GK, Nalamada

S, Naik MN HS. Orbital aspergillosis in

immunocompetent patients. Br J Ophthalmol.

; 98:1379-84.

Choi HS, Choi JY, Yoon JS, Kim SJ LS. Clinical

characteristics and prognosis of orbital invasive

aspergillosis. Ophthal Plast Reconstr Surg. 2008;

:454459.

Pushker N, Meel R, Kashyap S, Bajaj

MS SS. Invasive aspergillosis of orbit in

immunocompetent patients: Treatment and

outcome. Ophthalmology. 2011; 118:1886-91.

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Published

2020-07-29

How to Cite

GB, B. ., E, M. D., & E, A. . (2020). Rhino-orbital fungal infection mimicking orbital malignancy – is traditional herbal preparation a predisposing factor?: Report of two cases. The Journal of Ophthalmology of Eastern, Central and Southern Africa, 24(1). Retrieved from https://joecsa.coecsa.org/index.php/joecsa/article/view/180