Isolated orbito-cerebral mucormycosis

Area of Science:

• Mycology
• Infectious Diseases
• Vascular Medicine

Background:

• Rhino-orbito-cerebral mucormycosis (ROCM) is a life-threatening fungal infection predominantly affecting immunocompromised individuals.
• Timely diagnosis of ROCM is critical to prevent treatment delays and improve patient outcomes.
• The characteristic sign of ROCM is typically a black eschar, often found in the nasal cavity.

Observation:

• This case highlights an unusual presentation of fulminant ROCM potentially originating from an orbital infection.
• The patient presented with black eschars at the bilateral canthi, serving as the initial indicator of extensive vascular compromise.
• The infection rapidly progressed, leading to occlusion of the ophthalmic arteries and major intracranial arteries.

Findings:

• ROCM can manifest with orbital involvement without primary nasal or paranasal sinus disease.
• Orbital black eschars can be an early warning sign of rapidly progressing, fatal ROCM.
• Extensive vascular involvement, including ophthalmic and intracranial arteries, can occur in severe ROCM cases.

Implications:

• This case expands the understanding of ROCM's diverse clinical presentations and routes of acquisition.
• Ophthalmologists and infectious disease specialists should consider ROCM in cases of orbital infections with necrotic lesions.
• Prompt recognition of atypical ROCM presentations is vital for initiating aggressive, potentially life-saving treatment strategies.