¹University Hospital Zurich, Zurich, Schweiz

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Objectives and questions: Orbitocerebral mucormycosis caused by Apophysomyces elegans (A. elegans) is a rare infection, usually occurring in tropical and subtropical climates, with a high mortality. We report a case of orbitocerebral mucormycosis caused by A. elegans in an HIV-positive patient from Africa, supported by a systematic review of the literature to provide an update on current diagnostic and treatment strategies for orbitocerebral mucormycosis caused by A. elegans.

Material and methods: The presented case was treated in our hospital for polytrauma following a motor vehicle accident (MVA) with aggressive surgical debridement and therapy with liposomal Amphotericin B (AMB). We evaluated the clinical presentation, imaging, surgery and postoperative outcomes. A systematic review of English or German language articles (published between 1985 and 2023) was performed according to PRISMA guidelines. Articles describing patients with mucormycosis due to Apophysomyces were summarised. Quantitative values for relevant parameters indicating a reduction in mortality and morbidity were obtained.

Results: The systematic review identified 15 publications relevant to our focus. 14 (70%) were male and 6 (30%) were female. Six patients had suffered trauma prior to the orbitocerebral mucormycosis. The mean incubation period was 14.7 days. All patients were treated with AMB. Debridement was performed in 16 (80%) cases. Two cases refused surgery and two cases died before debridement could be performed. Orbital exenteration was performed in 15 (75%) cases and 14 (70%) patients survived the infection.

Discussion and conclusions: Mucormycosis due to Apophysomyces is a rare but potentially devastating condition in the literature. Based on our experience and the literature, we suggest that early diagnosis of A. elegans combined with therapy with liposomal AMB and aggressive surgical debridement is essential to reduce morbidity and mortality.