Mucormycosis On The Attack

To highlight a case report of rhino orbital mucormycosis in a young diabetic male that initially presented with mild non alarming symptoms, the consequences lead us to an understanding that it can have grave and life threatening complications if not treated aggressively.

Department of Ophthalmology , Combined Military Hospital Multan Cantt, Multan, Pakistan

A 37 year old male presented with complaints of sudden visual loss of right eye with headache and retrorbital pain. Ophthalmic examination revealed mild proptosis, conjunctival congestion and chemosis. Fundoscopy revealed central retinal artery occlusion in right eye. Computerized Tomography and Magnetic Resonance Imaging of orbit revealed sinusitis of right ethmoidal sinus with thinning of ipsilateral lamina papyracea and intraorbital extension. Endoscopic biopsy under Genral Anaesthesia was done.  Histopathology report revealed mucormycosis in right ethmoidal sinus.

He was started on Inj Amphotericin-B at a dose of 0.6 mg/kg/day with strict monitoring of renal and liver function. Unfortunately vision of right eye was no perception of light as the fungus had already invaded the retinal artery and caused its occlusion.

Mucormycosis is angioinvasive and can invade the central retinal artery causing occlusion. Early detection and management is of paramount importance as its tendency to invade arteries, involve the orbit and subsequently brain can have lethal effects.