Case Presentation:
A 66‐year‐old male with a past medical history of type II diabetes mellitus presented to the emergency room with one week of headache. He was initially diagnosed with sinusitis based on imaging results and negative ophthalmic examination. Three days after initial evaluation, he developed acute loss of vision in his right eye and was admitted to the hospital with presumed temporal arteritis based on his symptoms (headache, jaw claudication and vision loss) and an elevated ESR of 67. High dose steroids were initiated but the patient continued to have worsening headache despite 3 days of intravenous treatment. Repeat imaging and ophthalmologic examination raised concern for right sphenoid sinusitis causing optic nerve impingement. ENT performed sinuscopy and he was noted to have purulent discharge with final cultures consistent with mucormycosis. Patient was diagnosed with invasive rhino‐orbital mucormycosis and was started on intravenous antifungal medications.
Discussion:
Mucormycosis is a rare and life threatening fungal infection most commonly seen in patients with diabetes, especially those with ketoacidosis. Other risk factors include Immunocompromising conditions and extreme malnutrition. Mucormycosis is extremely rare and while its incidence is difficult to calculate accurately, it appears to be increasing secondary to rising numbers of immunocompromised persons. Patients usually present with nonspecific signs and symptoms of sinusitis including fever, nasal congestion and discharge, headache, and sinus pain. Diplopia and visual loss can be late symptoms that indicate invasion of the orbital nerves and vessels. Timely diagnosis is crucial in cases of mucormycosis, pateints with suspected rhinocerebral disease should undergo a CT scan of the paranasal sinuses and an endoscopic examination of their nasal passages. Treatment includes antifungal therapy (usually liposomal Amphotercin) and surgical resection.
Conclusions:
In this case, the patient had an atypical presentation of mucormycosis with signs and symptoms that initially led to a diagnosis of temporal arteritis. Although mucormycosis is a rare disease, early diagnosis and treatment could prevent a life threatening condition. Because of the lack of specific signs and symptoms of this disease, a high index of suspicion is necessary to establish the diagnosis and institute the appropriate treatment.