Carotid artery occlusion by rhinoorbitocerebral mucormycosis

Area of Science:

• Mycology
• Infectious Diseases
• Vascular Medicine

Background:

• Mucormycosis is a serious invasive fungal infection, ranking as the third most common type, predominantly affecting immunocompromised patients.
• Intracranial and extracranial arteriovenous vasculopathy complicates mucormycosis, significantly increasing treatment difficulty and patient mortality.
• The case highlights the severe manifestations of mucormycosis, including acute blindness and coma due to diabetic ketoacidosis.

Purpose of the Study:

• To present a case of mucormycosis with extensive vasculopathy in a young immunocompromised patient.
• To illustrate the challenges and multidisciplinary treatment approaches for this complex condition.
• To emphasize the critical need for aggressive management of mucormycosis-induced vasculopathy.

Main Methods:

• A 23-year-old female patient with acute blindness and diabetic ketoacidosis-induced coma was diagnosed with mucormycosis.
• Diagnostic imaging revealed nasal sinus, orbital, and frontal base lesions, with left carotid artery occlusion and cavernous sinus involvement.
• Confirmation of mucormycosis was achieved through endonasal debridement biopsies.

Main Results:

• The patient underwent extensive multidisciplinary treatment, including antimicrobial therapy and multiple surgical procedures (bilateral orbital exenteration).
• Initial recovery was remarkable, with the patient regaining verbal communication and motor function.
• Despite initial improvement, the patient experienced a disease recurrence and ultimately succumbed two months post-discharge.

Conclusions:

• Mucormycosis-induced vasculopathy presents a complex clinical challenge requiring aggressive and comprehensive treatment strategies.
• Early diagnosis and prompt, multidisciplinary intervention are vital for managing invasive fungal infections with vascular complications.
• While aggressive treatment can lead to temporary recovery, the prognosis for mucormycosis with vasculopathy remains grave due to the high risk of recurrence.