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[Rhino-orbital mucormycosis with orbital abscess: a case report]
Emel Cadallı Tatar1, Unzile Akpınar Sürenoğlu, Eray Işık
12nd Department of Otolaryngology, Ankara Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey.
Abstract:
Sinonasal mucormycosis is a rare, life-threatening and insidious fungal infection. Uncontrolled diabetes mellitus and immunsupression are the most important risk factors. The infection is clinically characterized by black necrotic tissues and crusting in the nasal cavity. In acute fulminant rhinosinusitis and particularly in infections caused by mucor species, black scar tissues seen on the nasal mucosa are pathognomonic. High level of suspicion in the risk group the diagnosis is confirmed by histopathological examination. The rhinoorbital form is even rarer and the findings may range from orbital pain to ophtalmoplegia and blindness. In this report we present a 72-year-old female patient with uncontrolled type 2 diabetes mellitus who was admited with the complaints of exophtalmos in the left eye, diplopia and headache. In the physical examination there was purulent discharge in the middle meatus and left orbital abscess was detected on computed tomography. We performed an emergency endoscopic sinus surgery. While we did not observe any necrotic tissues, granulation tissues were detected and pus was drained from the orbital cavity. The result of the histopathological examination was reported as invasive mucormycosis. We presented this case to emphasize the importance of early diagnosis and treatment of rhinoorbital mucormycosis.
Insights
Sinonasal mucormycosis, a rare fungal infection, can rapidly affect the eye socket. Early diagnosis and treatment are crucial for patients with uncontrolled diabetes mellitus to prevent vision loss.
Area of Science:
- Mycology
- Ophthalmology
- Otorhinolaryngology
Background:
- Sinonasal mucormycosis is a rare, life-threatening fungal infection.
- Uncontrolled diabetes mellitus and immunosuppression are key risk factors.
- Clinical signs include black necrotic tissues and nasal crusting.
Observation:
- A 72-year-old female with uncontrolled type 2 diabetes presented with left exophthalmos, diplopia, and headache.
- Physical examination revealed purulent discharge; CT identified a left orbital abscess.
- Emergency endoscopic sinus surgery drained pus, revealing granulation tissue, not necrosis.
Findings:
- Histopathological examination confirmed invasive mucormycosis.
- The rhinoorbital form, though rare, can lead to severe complications like blindness.
- Despite atypical presentation without necrosis, the diagnosis was confirmed.
Implications:
- This case highlights the importance of high clinical suspicion for rhinoorbital mucormycosis in at-risk patients.
- Prompt diagnosis and surgical intervention are vital for managing this aggressive infection.
- Early treatment can prevent devastating outcomes such as vision loss.
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