Dacryocystitis: an unusual form of Mucorales infection

Ahmad Halawa1, George Yacoub, Muhanad Al Hassan

  • 1James H. Quillen Veterans Affairs Medical Center, Mountain Home, TN 37684-4000, USA.

Insights

Mucormycosis, a severe fungal infection, can affect the lacrimal sac, particularly in immunocompromised individuals like diabetics. Early diagnosis and combined treatment of surgical debridement and antifungal therapy are crucial for successful outcomes.

Area of Science:

  • Ophthalmology
  • Mycology
  • Infectious Diseases

Background:

  • Mucormycosis is a rare but life-threatening fungal infection, predominantly affecting immunocompromised patients.
  • Risk factors include uncontrolled diabetes mellitus and ketoacidosis, which can predispose individuals to invasive fungal infections.
  • Ocular and orbital manifestations of mucormycosis, while uncommon, require prompt recognition and management.

Observation:

  • A case of a diabetic patient presenting with ketoacidosis and isolated lacrimal sac mucormycosis is described.
  • This represents the second reported instance of dacryocystitis caused by mucormycosis in medical literature.
  • Notably, the patient exhibited no concurrent sinus or orbital tissue involvement.

Findings:

  • The diagnosis was confirmed through microbiological and histopathological examination of the affected lacrimal sac.
  • Treatment involved a combination of aggressive surgical debridement of infected tissue and systemic antifungal medication.
  • The patient demonstrated a complete recovery without recurrence of the fungal infection.

Implications:

  • This case highlights the importance of considering mucormycosis in the differential diagnosis of lacrimal sac infections, especially in diabetic patients with ketoacidosis.
  • Isolated lacrimal sac mucormycosis, though rare, can occur without contiguous spread to sinuses or orbits.
  • Multimodal treatment including surgery and antifungals is effective for managing this severe infection.

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