An Interesting Case of Rhino-OrbitoCerebral Mucormycosis: A Case Report

Abstract

Fungal infections are the most challenging problems in an immunocompromised individual. Mucormycosis is a life-threatening fungal infection with rapid progression and high mortality in immunocompromised individuals. A case of 58-year-old female, with uncontrolled diabetes is with five days history of headache, fever, and acute onset drooping of the eyelid. The initial vision was normal which dropped to PL in the following days, with ophthalmoplegia and dilated nonreactive pupil in the right eye. Fundus and IOP were normal on presentation. MRI and MRV brain showed subtle ethmoidal cysts. CT-PNS showed mild ethmoidal thickening and cyst. Diagnostic nasal endoscopy showed unhealthy mucosa with no lesion suggesting eschar. A provisional diagnosis of orbital mucormycosis was made. The patient was started on antibiotics and IV Amphotericin B but she went on to further neurological complications. Despite treatment, she developed necrotising eschars in eyelid for which debridement was done. Further, exenteration was advised and patient developed septicaemia, however he died. The culture from debrided tissue showed growth of mucor. The objective of presenting this particular case is to emphasise the importance of considering mucormycosis as diagnosis despite subtle radiological and endoscopic findings in symptomatic immunocompromised patients. Early diagnosis and aggressive management improve better chances for survival.

Keywords

• amphotericin
• ethmoid sinus
• immunosuppression
• uncontrolled diabetes