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Rhino-Orbital Mucormycosis: A Rare Fungal Infection’s Devastating Impact on Vision
Table of Contents
- 1. Rhino-Orbital Mucormycosis: A Rare Fungal Infection’s Devastating Impact on Vision
- 2. what is the relationship between uncontrolled diabetes (specifically DKA) and the increased risk of developing rhino-orbital mucormycosis?
- 3. Rhino-orbital Mucormycosis Leading to Central Retinal Artery Occlusion: A Case Report
- 4. Understanding Rhino-orbital Mucormycosis (ROM)
- 5. Pathophysiology & Clinical Presentation
- 6. Case Report: A 62-Year-Old Male with Uncontrolled Diabetes
- 7. diagnostic Workup
- 8. Treatment & management
A recent case report sheds light on a severe complication where a fungal infection led to central retinal artery occlusion, a critical cause of sudden vision loss.
A concerning case has emerged,highlighting a rarely seen yet critical complication of rhino-orbital mucormycosis. This aggressive fungal infection,often associated with uncontrolled diabetes,has been linked to central retinal artery
what is the relationship between uncontrolled diabetes (specifically DKA) and the increased risk of developing rhino-orbital mucormycosis?
Rhino-orbital Mucormycosis Leading to Central Retinal Artery Occlusion: A Case Report
Understanding Rhino-orbital Mucormycosis (ROM)
Rhino-orbital mucormycosis (ROM), a rare but aggressive fungal infection, primarily affects immunocompromised individuals.It’s caused by fungi belonging to the order Mucorales, commonly rhizopus, Mucor, and Lichtheimia. The infection typically begins in the nasal cavity and paranasal sinuses, rapidly spreading to the orbit and perhaps the brain. Early diagnosis and aggressive management are crucial to prevent devastating outcomes, including vision loss and mortality. This article details a case report highlighting a particularly severe manifestation: central retinal artery occlusion (CRAO). Keywords: mucormycosis, ROM, fungal sinusitis, orbital infection, central retinal artery occlusion, CRAO, immunocompromised, Rhizopus, Mucor, Lichtheimia.
Pathophysiology & Clinical Presentation
The pathogenesis of ROM involves fungal spore inhalation, particularly in individuals with impaired immune defenses.Predisposing factors include:
Diabetic Ketoacidosis (DKA): A meaningful risk factor, especially uncontrolled diabetes.
Immunosuppression: From conditions like HIV/AIDS, organ transplantation, or chemotherapy.
Iron Overload: Conditions like thalassemia or iron overload syndromes.
Deferoxamine use: An iron-chelating agent.
Glucocorticoid Therapy: Prolonged use of corticosteroids.
Clinical presentation is frequently enough aggressive and rapidly progressive. Common symptoms include:
Nasal Congestion & Pain: Often unilateral.
Periorbital Edema: Swelling around the eye.
Proptosis: Bulging of the eye.
Ophthalmoplegia: Paralysis of eye muscles.
Black Necrotic Tissue: A characteristic, tho not always present, finding in the nasal cavity or palate.
Headache & Facial Pain: Indicating potential intracranial extension.
Case Report: A 62-Year-Old Male with Uncontrolled Diabetes
A 62-year-old male with a history of poorly controlled type 2 diabetes presented with a 7-day history of left-sided facial pain, nasal congestion, and progressively worsening vision loss in the left eye. Initial examination revealed left-sided proptosis, complete ophthalmoplegia, and a fixed, dilated pupil. Fundoscopic examination showed a cherry-red spot indicative of central retinal artery occlusion (CRAO).
diagnostic Workup
Non-Contrast CT Scan: demonstrated complete opacification of the left maxillary sinus and evidence of orbital involvement.
MRI with Contrast: Confirmed extensive fungal invasion of the sinuses and orbit, extending towards the intracranial cavity.
Nasal Biopsy & Culture: Revealed broad, non-septate hyphae consistent with Rhizopus oryzae. Culture confirmed the diagnosis of rhino-orbital mucormycosis.
Blood Glucose Levels: Significantly elevated, confirming diabetic ketoacidosis (DKA).
Complete Blood Count (CBC): Showed leukocytosis with neutrophilic predominance.
Treatment & management
Immediate treatment was initiated with:
- Aggressive Surgical Debridement: Endoscopic sinus surgery was performed to remove all necrotic and infected tissue. Multiple debridements were required.
- Systemic Antifungal Therapy: Liposomal amphotericin B (LAmB) was administered intravenously at a dose of 5mg/kg/day.
- DKA Management: Intravenous fluids, insulin therapy, and electrolyte correction were implemented to stabilize the patient’s diabetic state.
- Hyperbaric Oxygen Therapy (HBOT): Adjunctive HBOT sessions were considered, though access was limited.
- Monitoring: Frequent clinical and radiological assessments were performed to evaluate treatment response.
Despite aggressive intervention,the patient experienced irreversible vision loss in the left eye due to the CRAO. the CRAO is
