Rhino-Orbital Mucormycosis in Diabetes Mellitus : A Case Report

Abstract

     Mucormycosis is a rare fungal infection that affects immunocompromised patients. Rhino-orbito-cerebral presentation is the most common clinical form of the disease, often associated with diabetes mellitus. It is recognized as one of the most rapidly progressive lethal form of fungal infection in human being with a high motality rate of 70-100%. Successful management of this fulminant infection requires early recognition of the disease and aggressive medical and surgical interventions to prevent the high morbidity and motality associated with the disease process. The author presents a 75-years-old diabetic woman who complained of left periorbital pain associated with progressive deficit of vision and ocular movement. Ocular imaging showed signs of orbital cellulitis and pansinusitis. After intravenous antibiotics and histological examination of biopsied specimen from sinuses, the mucosal specimens showed separated colonies of fungal hyphae with right angle branching suggestive of mucormycosis. The patient was started on intravenous amphotericin B and diabetic control. Eventually orbital exenteration was performed when the lesion progressed to osteomyelitis of orbital roof and anterior clinoid process. This report emphazises that clinicians should be aware of mucormycosis presenting as orbital cellulitis in diabetes patients. Prompt diagnosis and institution of antifungal treatment are critical in decreasing morbidity and mortality of this infection.