PurposeTo demonstrate the successful clinical identification and management of rhino-orbital mucormycosis, a fungal infection with a high mortality rate.Patients and methodsA diabetic male patient with a headache and orbital apex syndrome in the right eye was examined using computed tomography (CT) and magnetic resonance imaging (MRI) for a possible fungal infection. Endoscopic surgical resection was performed and a pathology sample was taken. Specimens were prepared with Gömöri methenamine silver and hematoxylin and eosin staining. The patient was treated with liposomal amphotericin B 400 mg daily, followed by posaconazole 400 mg twice daily.ResultsCT and MRI revealed a mass of the right sphenoid spreading into the orbit, indicative of a fungal infection. The biopsy confirmed the diagnosis of mucormycosis. Complete recovery of eyelid and oculomotor function was achieved after 10 months of treatment, although the patient continues to suffer from irreversible blindness in the right eye due to optic nerve atrophy. He has been without signs or symptoms of recurrence.ConclusionPatients with rhino-orbito-cerebral mucormycosis need extensive surgical and medical treatment to maximize outcomes. Success requires multidisciplinary management.

Stevens-Johnson syndrome, toxic epidermal necrolysis, and erythema multiforme are life threatening diseases causing mucocutaneous eruptions and can be difficult to manage medically. When oral tissues are involved, airway management can be of critical importance. Fluid and electrolyte imbalance are common and protocols to prevent secondary infection are initiated. All three conditions are rapidly evolving. Stevens-Johnson syndrome is more commonly associated with Mycoplasma pneumoniae in the pediatric population and drug hypersensitivity in adults, whereas erythema multiforme is mostly associated with herpes simplex virus in the adult population. These diseases are T-cell-mediated immune reactions, thought to represent a spectrum of the same disease. Clinical and immunohistochemical techniques are capable of differentiating Stevens-Johnson syndrome from erythema multiforme and provide insight into the possible underlying pathology creating the disease. Rare cases of Stevens-Johnson syndrome without skin manifestations have been associated with Mycoplasma pneumoniae and predominantly occur in males. In-hospital management is recommended to provide airway support, maintain fluid intake, electrolyte balance, obtain multi-speciality consultation, and to perform diagnostic testing. We describe a case of a 14 year old male with atypical Stevens-Johnson syndrome and a review of the literature.

Traumatic causes of orbital apex and superior orbital fissure syndrome are uncommon. The authors present the first case of a traumatic superior orbital fissure syndrome simulating orbital apex syndrome, with loss of vision from posterior ischemic optic neuropathy. A 35-year-old man was initially felt to have a right orbital apex syndrome with left craniofacial and orbital trauma. CT revealed left orbital fractures, a right superior orbital fissure fracture, a retained metallic foreign body in the right sphenoid sinus, and a right frontoparietal subdural hematoma. CT angiography showed a secondary dissection and occlusion of the right internal carotid artery from osseous erosion of the posterolateral wall of the sphenoid sinus. Internal carotid artery dissection is a possible, though rare, cause of ischemic optic neuropathy. The right pseudo-orbital apex syndrome resulted from a mechanical superior orbital fissure syndrome and posterior ischemic optic neuropathy from an internal carotid artery dissection.

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