Temporal Artery Calciphylaxis Presenting as Temporal Arteritis in a Case of Rhinoorbitocerebral Mucormycosis.
Mucormycosis is a rare often fatal opportunistic fungal infection. It is typically described in patients with diabetes in ketoacidotic status and is rare in renal transplant recipients. Calciphylaxis is a rare and highly morbid disease of vascular calcification affecting patients with end-stage renal disease (ESRD). The first case of a renal transplant recipient who was inflicted with both rhinoorbitocerebral mucormycosis and calciphylaxis is reported. A 45-year-old man presented with 2-day history of left upper blepharoptosis, periorbital pain, left-sided headache, binocular diplopia, and left V2 numbness. He had undergone renal transplant for ESRD 7 months earlier with resultant immunosuppressive therapy. MRI and nasal biopsy confirmed rhinoorbitocerebral mucormycosis. Immunosuppressive therapy was stopped and antifungal therapy begun. He had orbital exenteration for progressive rhinoorbitocerebral mucormycosis. Two months later, the patient reported new-onset intermittent bitemporal headache and bilateral swollen, tender temporal arteries. Temporal artery biopsy revealed features consistent with calciphylaxis. Clinical presentation, treatment course, and follow up are discussed.
*Department of Ophthalmology, Gachon University Gil Hospital, Incheon, Korea; †Department of Ophthalmology, University of California San Francisco, San Francisco, California; ‡Permanente Medical Group, Hayward, California; and §Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, U.S.A.
Mijung
M
Chi
H Jane
HJ
Kim
Ryan
R
Basham
Michael K
MK
Yoon
Reza
R
Vagefi
Robert C
RC
Kersten
D000935:Antifungal Agents / Q000627:therapeutic use; D002115:Calciphylaxis / Q000175:diagnosis* / Q000382:microbiology / Q000628:therapy; D020314:Central Nervous System Fungal Infections / Q000175:diagnosis* / Q000382:microbiology / Q000628:therapy; D003131:Combined Modality Therapy; D015821:Eye Infections, Fungal / Q000175:diagnosis* / Q000382:microbiology / Q000628:therapy; D013700:Giant Cell Arteritis / Q000175:diagnosis* / Q000382:microbiology / Q000628:therapy; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016030:Kidney Transplantation; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009091:Mucormycosis / Q000175:diagnosis* / Q000382:microbiology / Q000628:therapy; D019635:Neurosurgical Procedures; D009668:Nose Diseases / Q000175:diagnosis* / Q000382:microbiology / Q000628:therapy; D009894:Opportunistic Infections; D009916:Orbital Diseases / Q000175:diagnosis* / Q000382:microbiology / Q000628:therapy; D012233:Rhizopus / Q000302:isolation & purification; D013699:Temporal Arteries / Q000473:pathology*
D000935:Antifungal Agents; D007166:Immunosuppressive Agents