Clinical Reasoning: Monocular vision loss, ophthalmoplegia, and strokes in a 61-year-old man with diabetes mellitus

Lamotte, Guillaume; Farzal, Zehra; Zimmerman, William Denney; Han, Suhua; Brito, Pedro de; Mayson, Douglas

doi:10.1212/wnl.0000000000004742

Cited by 1 publication

(1 citation statement)

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“… 8 The list of signs and symptoms that should be considered to be “red flags” includes a cranial nerve palsy, diplopia, sinus pain, proptosis, periorbital swelling, orbital apex syndrome, and ulcers of the palate. 9 , 10 Microscopy (direct and histopathology) and culture of various clinical specimens are the cornerstones of diagnosing Mucormycosis. 11 New generation sequencing of the cell free DNA is a relatively new noninvasive diagnostic tool which successfully detects and identifies species of various infectious pathogens including Aspergillus and non-Aspergillus molds.…”

Section: Discussionmentioning

confidence: 99%

A 40-Year-Old Woman With COVID-19 and Bilateral Vision Loss

Jain

Senetar

Maciel

et al. 2022

The Neurohospitalist

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Mucormycosis is a fast-spreading angioinvasive fungal infection with a very high mortality rate. It is associated with immunodeficiency, diabetes mellitus, iron overload, stem cell transplantation and the use of steroids. As cultures and histopathological biopsy may have low yield in invasive fungal infections, new generation sequencing of cfDNA (cell free deoxyribonucleic acid) has become a cornerstone for diagnosis. Over the past 18 months, increasing reports of COVID-19 associated Mucormycosis have emerged, most specifically in India and other nearby developing countries. Awareness and knowledge of this newly discovered association is of high importance and clinical relevance as the global COVID-19 pandemic continues. Herein, we present a case of a patient who was treated with steroids for COVID-19 in the outpatient setting and presented with unilateral periorbital pain and blurry vision. She progressively developed bilateral vision loss, fixed bilateral mydriasis, ophthalmoplegia and coma. Imaging findings included leptomeningeal, vascular, and subcortical enhancement accompanied with multifocal infarction. Subsequent biopsy of the paranasal sinuses revealed broad type fungal elements and cfDNA sequencing identified the pathogen as Rhizopus species. She was treated with intravenous amphotericin B, but succumbed to the infection.

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