Invasive Mucormycosis Causing Rhino-orbital Cellulitis

Abstract

INTRODUCTION Mucormycosis manifests in a variety of different clinical presentations in humans, particularly in immunocompromised patients and those with diabetes mellitus. 1 The agents of mucormycosis are common in the environment and can be found on decaying vegetation and in the soil. 2 All humans have ample exposure to these fungi during day-today activities. The fact that mucormycosis is a rare human infection reflects the effectiveness of the intact human immune system. This is supported by the finding that almost all human infections, due to the agents of mucormycosis, occur in the presence of some underlying compromising condition. We report a case of devastating rhino-orbital mucormycosis in a patient with uncontrolled diabetes resulting in exenteration of the left eye. Prognosis is poor for patients with brain, cavernous sinus, or carotid involvement. 3-5 Hence, it is important to make an early diagnosis and initiate appropriate treatment, along with strict glycemic control in diabetics, to decrease morbidity and mortality. CASE REPORT A 67-year-old male with stage IV chronic kidney disease, sleep apnea, coronary artery disease status post coronary artery bypass graft, and uncontrolled diabetes mellitus presented to an outside hospital with headache, nasal congestion, diplopia, and photophobia. The patient had invasive fungal sinusitis and underwent endoscopic sinus surgery and debridement. Cultures grew Rhizopus. The patient was transferred to our hospital after he became blind in the left eye (reportedly the night prior to transfer) for further aggressive management with endoscopic sinus surgery for debridement of invasive fungal sinusitis. On exam, the patient had proptosis of the left eye. He had left afferent pupillary defect, severely restricted gaze, and decreased