Insurge Of Pandemic,All Red Inflamed Eyes Are Not By Black Bugs.

To overcome the clinical diagnostic dilemma of b/l PUK when masquerading as suspected MUCOR Mycosis

During the 2nd surge of COVID pandemic,pt. presented with B/L orbital swelling with h/o uncontrolled IDDM 

A 45 yr female presented with sudden periorbital swelling in Both Eyes diagnosed a s LE preseptal cellulitis and started with IV Antibiotics and COVID RTPCR was negative. She was referred for Cornea consultation.Clinically BE PUK + periorbital inflammation. Investigation- OU scraping Negative ,MRI brain s/o Mucor Lesion. CT paranasl sinus is WNL. Blood for CRP, ESR , RA -All are High;Anca and Repeat RTPCR were negative. Medications - eye drop Gatifloxacin,Homatropin , CMC, low dose Loteprednol and oral Itraconazole started,but inspite of aggressive medication,progressive inflammation and infiltration notices. 

Moderate Symptomatic improvement with Significant thinning of LE as frank PUK with Topical Low strength Steroids with close monitoring  and after a consultation with ENT and Physician,oral WYSOLONE 0.5mg/kg/day started and Significant improvement noted.

During the surge of pandemic with uncontrolled DM ,diagnosis of B/L PUK with inflamed eye is challenging when masquerading as suspected Mucor mycosis.

RA accounts for 8-15% causes of Scleritis and 2% of RA will develope peri orbital inflammation which has to be treated with systemic steroid and immunomodulator - These are the clinical pearls of this presentation