Orbital Infection by Saksenaea vasiformis in an Immunocompetent Host

Abstract

Orbital mucormycosis caused by Saksenaea vasiformis is extremely rare. Herein, we report an immunocompetent 22-year-old Thai female who presented with two months of progressive right upper eyelid mass, associated with swelling, redness, and ptosis. She failed to improve despite multiple courses of antibiotic and steroid treatment. Computed tomography (CT) scan showed infiltration involving the upper eyelid and lacrimal gland. Fungal hyphae were revealed by histopathological study. Polymerase chain reaction (PCR) was positive for Saksenaea vasiformis (GenBank: accession number FR687327.1). The patient was successfully treated with surgical debridement, amphotericin B, and oral posaconazole.

Diagnostic Utility of Polymerase Chain Reaction for Paraffin-embedded Sinus Specimens for Rhinocerebral Mucormycosis Complicated by Internal Carotid Artery Thrombosis and Cerebral Infarction

“…There have been a few case reports concerning the application of PCR using tissue samples in patients with rhinocerebral mucormycosis (Table) (7)(8)(9)(10)(11). However, there have been no reports on rhinocerebral mucormycosis complicated by an ischemic stroke.…”

COVID-19 associated mucormycosis: evolving technologies for early and rapid diagnosis

“…Risk factors include Hyperglycemia, Hyperferritinemia, low pH, and decreased phagocytic defense Cutaneous infections with grey-black plaques, extensive necrosis. Rhino-cerebral infections involve typical black necrotic nasal turbinate, swelling, inflammation, and rarely direct trauma (Scalise et al 1999 ; Ribes et al 2000 ; Rickerts et al 2006 ; Blomberg et al 2007 ) Apophysomyces elegans Respiratory, Percutaneous, postoperative surgical wounds Skin, sinuses, bone, muscles, fat, kidney, bladder, orbital tissue, central nervous tissue, and less frequently disseminated infections Thermotolerance, proteases, siderophores Soil-contaminated wounds, immunocompromised (severe burns and organ transplants) and diabetic individuals, Necrotizing cellulitis, tissue, and angioinvasion, painful swelling, edema, extensive thrombosis, black hemorrhagic or white and friable lesions (Cooter et al 1990 ; Neblett Fanfair et al 2012 ; Egge et al 2018 ; Rashid et al 2021 ) Saksenaea vasiformis Open, soil contaminated cutaneous wounds and/or lesions, Skin, sinuses No specific virulence factors Individuals with open wounds together with trauma, immunocompromised hosts due to antibiotics, steroid treatment or with an in-dwelling catheter, leukemia with neutropenia, diabetes, thalassemia, and splenectomy Cutaneous lesions with painful red blisters and peeling skin with purulent eschar, less frequent evidence of cheesy necrosis or friable tissue Abscess formation in sinuses (Saksena 1953 ; Gomes et al 2011 ; Pilch et al 2017 ; Lumyongsatien et al 2020 ) Cunninghamella bertholletiae Upper respiratory tract, GI tract, percutaneous, cutaneous, and subcutaneous Eyes, ears, lungs, skin, sinuses, brain, joints, liver, and kidneys Thermotolerance Individuals with a compromised immune system, hematologic malignancies, neutropenia, diabetes, acidosis, nonmalignant hematologic conditions, hyperglycemia, iron overload, treatment with broad-spectrum antibiotics, predisposed infections of HIV, CMV, and HCV Angioinvasion, hemoptysis, multiple cavities in lower and upper lobes of lungs <...>…”