amphotericin-b and Blepharoptosis

A middle-aged woman with diabetes presented with left-sided facial pain, complete ptosis and fever of short duration. On presentation, she had hyperglycaemia without ketosis. There was total ophthalmoplegia of the left eye with a visual acuity of 6/36. She incidentally tested positive for COVID-19. CT paranasal sinus and MRI brain revealed left-sided pansinusitis with acute infarct in the left parieto-occipital region without angioinvasion. An emergency functional endoscopic sinus procedure was done, which confirmed mucormycosis on histopathological examination. After 1 week of conventional amphotericin B and antibiotics, repeat CT brain showed improvement in mucosal thickening and sinusitis. This case is a rare presentation of mucormycosis associated with rapid progression to orbital apex syndrome with brain infarction in a patient with non-ketotic diabetes and COVID-19. Early diagnosis and treatment are essential to prevent further end-organ damage. It is also interesting that there was no angioinvasion and transient periarterial inflammation was attributed to brain infarction.

Topics: Amphotericin B; Antifungal Agents; Blepharoptosis; Brain; COVID-19; Diabetes Complications; Female; Humans; Magnetic Resonance Imaging; Middle Aged; Mucormycosis; Ophthalmoplegia; Orbital Diseases; Paranasal Sinus Diseases; SARS-CoV-2; Tomography, X-Ray Computed; Treatment Outcome

We describe an elderly diabetic patient presenting with sudden onset right-sided proptosis and vision loss secondary to rhino-orbital mucormycosis and central retinal vascular occlusion. He underwent orbital exenteration that was complicated by intraoperative cerebrospinal fluid (CSF) leak from lateral orbital wall. The leak was surgically repaired and the patient recovered well. We postulate the cause of the CSF leak to be twofold: necrotic periorbital tissue due to mucormycosis rendering the thin bones susceptible to damage and second, intraoperative manipulation and dissection at the orbital apex with monopolar cautery and instruments. We describe measures taken to successfully repair the CSF leak and the possible precautions that can be taken to avoid it.

Topics: Administration, Intravenous; Amphotericin B; Antifungal Agents; Blepharoptosis; Blindness; Cerebrospinal Fluid Leak; Debridement; Diabetes Mellitus, Type 2; Endoscopy; Humans; Hyphae; Intraoperative Complications; Magnetic Resonance Angiography; Male; Middle Aged; Mucormycosis; Orbit; Orbit Evisceration; Orbital Diseases; Paranasal Sinuses; Retinal Artery Occlusion; Sinusitis; Treatment Outcome

Topics: Amphotericin B; Animals; Antifungal Agents; Aspergillosis; Aspergillus fumigatus; Blepharoptosis; Combined Modality Therapy; Debridement; Diabetes Mellitus, Type 2; Diagnosis, Differential; Ethmoid Sinusitis; Humans; Immunocompromised Host; Male; Maxillary Sinusitis; Nasal Mucosa; Orbit; Osteolysis; Paranasal Sinus Neoplasms; Radiography

Topics: Amphotericin B; Antifungal Agents; Blepharoptosis; Cellulitis; Diabetes Complications; Diagnosis, Differential; Enterobacter aerogenes; Enterobacteriaceae Infections; Humans; Male; Middle Aged; Mucormycosis; Necrosis; Ophthalmoplegia; Orbit; Orbital Diseases; Rhizopus; Sinusitis; Vision Disorders; Visual Acuity; Zygomycosis

Rhinocerebral mucormycosis (phycomycetes), a human fungal disease with oral and perioral findings, has an extremely high morbidity and mortality. The disease is most frequently seen in patients with poorly controlled diabetes. The symptoms, findings, and treatment of rhinocerebral mucormycosis are discussed, and two case histories are presented.

Topics: Adult; Amphotericin B; Blepharoptosis; Cellulitis; Diagnosis, Differential; Eye Diseases; Female; Humans; Male; Maxillary Sinus; Middle Aged; Mucormycosis; Nose Diseases; Ophthalmoplegia; Orbit; Palatal Neoplasms; Palate; Paranasal Sinus Neoplasms; Paresthesia; Radiography; Sinus Thrombosis, Intracranial; Ulcer; Vision Disorders

Topics: Adult; Amphotericin B; Blepharoptosis; Blindness; Central Nervous System Diseases; Chronic Disease; Diabetes Complications; Follow-Up Studies; Fungi; Humans; Male; Mycoses; Ophthalmoplegia; Orbit

Topics: Adrenal Cortex Hormones; Amphotericin B; Biopsy; Blepharoptosis; Blindness; Brain Diseases; Child; Child, Preschool; Conjunctiva; Edema; Exophthalmos; Eye Diseases; Humans; Inflammation; Male; Mucormycosis; Paranasal Sinuses; Penicillins; Sinusitis

Topics: Adult; Amphotericin B; Blepharoptosis; Blindness; Contact Lenses; Diabetes Complications; Eye Diseases; Female; Humans; Middle Aged; Mucormycosis