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Rhino-Orbital Cerebral Mucormycosis in a Diabetic Patient: An Emergency Medicine Case Report
Raphael Sweet1, Michael Hovenden1, Carrie E Harvey2
1Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan.
Background:
Rhino-orbital cerebral mucormycosis (ROCM) is a rare infection caused by an invasive fungus and found predominantly in immunocompromised patients. The presentation of ROCM ranges from a mild headache, fever, and sinusitis to vision loss, altered mental status, and facial disfigurement secondary to local tissue invasion. ROCM can cause significant morbidity and mortality and requires prompt diagnosis with timely evaluation by surgical and infectious disease specialists. Cases of ROCM have been reported extensively in internal medicine, infectious disease, and otolaryngology literature. However, there are very few reports in emergency medicine literature in the United States.
Case Report:
A 72-year-old woman presented to the Emergency Department (ED) with altered mental status, 4 days of left-sided facial numbness and weakness, and sudden facial pain, swelling, and erythema. Laboratory analysis was consistent with diabetic ketoacidosis. Noncontrast computed tomography of the head and magnetic resonance imaging of the brain demonstrated findings indicative of invasive fungal infection of the left sinus and orbit with extension to the cavernous sinus and surrounding cranial nerves. She was initiated on broad-spectrum antifungals, but based on the extent of the infection, was not a surgical candidate. She subsequently transitioned to a comfort-based plan of care and died 6 days after initial ED presentation. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Early recognition and initiation of treatment can potentially mitigate the devastating outcomes of ROCM, therefore it is critical to be aware of this condition and have a high level of suspicion in susceptible patients.
Insights
Rhino-orbital cerebral mucormycosis (ROCM) is a rare fungal infection affecting immunocompromised individuals. Early recognition by emergency physicians is crucial for potentially mitigating severe outcomes in susceptible patients.
Area of Science:
- Emergency Medicine
- Infectious Diseases
- Otolaryngology
Background:
- Rhino-orbital cerebral mucormycosis (ROCM) is a rare, invasive fungal infection primarily affecting immunocompromised patients.
- ROCM presents with a spectrum of symptoms, from mild sinusitis to severe vision loss and facial disfigurement.
- Prompt diagnosis and specialist evaluation are critical for managing ROCM due to its high morbidity and mortality.
Observation:
- A 72-year-old female presented to the ED with altered mental status, facial numbness, weakness, pain, swelling, and erythema.
- Diabetic ketoacidosis was noted, and imaging revealed invasive fungal infection of the left sinus and orbit with intracranial extension.
- Despite antifungal treatment, the patient was not a surgical candidate and died within days of presentation.
Findings:
- The case highlights the severe presentation of ROCM in an emergency department setting.
- Imaging findings confirmed extensive invasive fungal sinusitis and orbital involvement.
- The patient's comorbidities and the advanced stage of infection precluded surgical intervention.
Implications:
- Emergency physicians must maintain a high index of suspicion for ROCM in at-risk populations presenting with compatible symptoms.
- Timely recognition and initiation of appropriate management can potentially improve patient outcomes.
- This case underscores the importance of interdisciplinary collaboration in managing rare and aggressive infections like ROCM.
