Indolent orbital apex syndrome caused by occult mucormycosis.
The chronic or indolent presentation of rhino-orbital mucormycosis, as defined by the presence of symptoms for more than 1 month before diagnosis, is extremely unusual. A 45-year-old man with stable diabetes presented with a right orbital apex syndrome and minimal ethmoid and sphenoid sinusitis. Progression was indolent, and the diagnosis was not made until 7 weeks after admission, when a third biopsy was prompted by new cavernous sinus and carotid artery thromboses. Mucormycosis was found. The patient improved on amphotericin B (2 g) and strict blood glucose control. A remarkable aberrant regeneration of the right oculomotor nerve was seen following treatment. He remains free of active disease 4 years later. Orbital symptoms in well-controlled diabetics, which may even remain stable for weeks and lack direct signs of tissue invasion, should raise the suspicion of mucormycosis.
Dooley
D P
DP
Department of Medicine, Brooke Army Medical Center, Fort Sam Houston, Texas.
Hollsten
D A
DA
Grimes
S R
SR
Moss
J
J
D002341:Carotid Artery Thrombosis / Q000209:etiology; D002426:Cavernous Sinus; D003389:Cranial Nerve Diseases / Q000382:microbiology*; D015521:Ethmoid Sinusitis / Q000382:microbiology; D015821:Eye Infections, Fungal / Q000150:complications; D006801:Humans; D008297:Male; D008875:Middle Aged; D009091:Mucormycosis / Q000150:complications; D009916:Orbital Diseases / Q000150:complications / Q000382:microbiology*; D012851:Sinus Thrombosis, Intracranial / Q000209:etiology; D015524:Sphenoid Sinusitis / Q000382:microbiology; D013577:Syndrome