Painless orbital apex syndrome from mucormycosis.
A 66-year-old woman with a history of non insulin-dependent diabetes mellitus, hypertension, and hypothyroidism presented with a painless orbital apex syndrome without any sign of orbital cellulitis or acute systemic disease. Her blood glucose was mildly elevated, but there was no diabetic ketoacidosis. Neuroimaging revealed only mild sinus disease. Transnasal sphenoidal mucosal biopsy showed an inflammatory mass with cellular atypia on frozen sections, suggesting squamous cell carcinoma. However, review of the permanent sections showed broad, nonseptate hyphae consistent with mucormycosis. The patient was treated with a 3-month course of intravenous amphotericin B and no further surgery. Examination 3 months after presentation revealed complete resolution of her ocular motility deficits and partial resolution of her optic neuropathy. Mucormycosis should be suspected in any case of orbital apex syndrome, especially in the diabetic patient.
Balch
K
K
Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia, USA.
Phillips
P H
PH
Newman
N J
NJ
D000368:Aged; D000666:Amphotericin B / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D015821:Eye Infections, Fungal / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D009091:Mucormycosis / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D015835:Ocular Motility Disorders / Q000175:diagnosis / Q000382:microbiology; D009901:Optic Nerve Diseases / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology; D009916:Orbital Diseases / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D010254:Paranasal Sinus Diseases / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology; D013101:Sphenoid Sinus / Q000382:microbiology / Q000473:pathology; D013577:Syndrome; D014057:Tomography, X-Ray Computed
D000935:Antifungal Agents; D000666:Amphotericin B