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Bilateral cavernous sinus thrombosis due to mucormycosis
E Van Johnson1, L B Kline, B A Julian
1Combined Program in Ophthalmology, Eye Foundation Hospital, Birmingham, AL.
Archives of Ophthalmology (Chicago, Ill. : 1960)
|August 1, 1988
Summary
A patient on hemodialysis developed a rare fungal infection (mucormycosis) and vision loss, potentially linked to deferoxamine treatment for hemochromatosis. This case highlights diagnostic challenges in fungal sinusitis and cavernous sinus thrombosis.
Area of Science:
- Ophthalmology
- Infectious Diseases
- Neurosurgery
Background:
- End-stage renal disease (ESRD) patients undergoing hemodialysis are susceptible to opportunistic infections.
- Deferoxamine, used for iron overload (hemochromatosis), can be associated with an increased risk of mucormycosis.
- Orbital and cerebral complications of fungal sinusitis can be rapidly progressive and life-threatening.
Observation:
- A 49-year-old male on hemodialysis presented with orbital cellulitis and bilateral central retinal artery occlusions.
- Initial cranial CT revealed sinusitis, but sinus biopsies were nondiagnostic.
- Autopsy confirmed cerebral mucormycosis, cavernous sinus thrombosis, and carotid artery thrombosis.
Findings:
- Cerebral mucormycosis was diagnosed post-mortem in a hemodialysis patient with hemochromatosis treated with deferoxamine.
- The patient experienced vision loss due to bilateral central retinal artery occlusions secondary to the fungal infection.
- Nondiagnostic sinus biopsies and limitations of neuroimaging in diagnosing invasive fungal sinusitis and cavernous sinus thrombosis were noted.
Implications:
- Deferoxamine therapy in ESRD patients may warrant closer monitoring for mucormycosis.
- Improved diagnostic modalities are needed for early detection of invasive fungal sinusitis and associated vascular complications.
- This case underscores the critical role of autopsy in identifying rare and aggressive infections in immunocompromised patients.