Facial Nerve Palsy with Total Ophthalmoplegia; a Novel Presentation of Fungal Invasion
Archives of Academic Emergency Medicine,
Vol. 9 No. 1 (2021),
1 Dey 2021
,
Page e54
https://doi.org/10.22037/aaem.v9i1.1305
Abstract
Mucormycosis is an expeditious invasion of a fungus of angioinvasive nature, predominant in immunocompromised individuals, often leading to organ malfunction and loss. Facial nerve involvement and total ophthalmoplegia are its rare presentations. Early detection and treatment can alter natural disease course and prevent potential catastrophic outcomes in diabetic patients. Facial nerve palsy is mostly attributed to peripheral neuropathy in patients with advanced diabetes mellitus. It rarely raises alarm about an invasive fungal infection. Here, we report the case of a 38-year-old male with type 2 diabetes mellitus, who presented to us with left lower motor neuron type facial palsy and left-sided total ophthalmoplegia due to invasive rhino-orbito-cerebral mucormycosis (ROCM). Despite aggressive measures, including antifungal therapy and repeated endoscopic debridement, he subsequently developed central retinal artery occlusion (CRAO) and underwent left eye exenteration.
- Mucormycosis
- diabetes mellitus
- facial paralysis
- retinal artery occlusion
How to Cite
References
Mohammadi R, Nazeri M, Sayedayn SMA, Ehteram H. A successful treatment of rhinocerebral mucormycosis due to Rhizopus oryzae. Journal of research in medical sciences: the official journal of Isfahan University of Medical Sciences. 2014;19(1):72.
Roden MM, Zaoutis TE, Buchanan WL, Knudsen TA, Sarkisova TA, Schaufele RL, et al. Epidemiology and outcome of zygomycosis: a review of 929 reported cases. Clinical infectious diseases. 2005;41(5):634-53.
Bitar D, Van Cauteren D, Lanternier F, Dannaoui E, Che D, Dromer F, et al. Increasing incidence of zygomycosis (mucormycosis), France, 1997–2006. Emerging infectious diseases. 2009;15(9):1395.
Rees JR, Pinner RW, Hajjeh RA, Brandt ME, Reingold AL. The epidemiological features of invasive mycotic infections in the San Francisco Bay area, 1992–1993: results of population-based laboratory active surveillance. Clinical Infectious Diseases. 1998;27(5):1138-47.
Narayanan S, Panarkandy G, Subramaniam G, Radhakrishnan C, Thulaseedharan N, Manikath N, et al. The “black evil” affecting patients with diabetes: a case of rhino orbito cerebral mucormycosis causing Garcin syndrome. Infection and drug resistance. 2017;10:103.
Sachdeva K. Rhino-oculo cerebral mucormycosis with multiple cranial nerve palsy in diabetic patient: review of six cases. Indian Journal of Otolaryngology and Head & Neck Surgery. 2013;65(4):375-9.
Mane R, Patil B, Mohite A, Mohanty R. Facial Nerve Palsy: An Unusual Presentation in Patients with Rhino Cerebral Mucormycosis. Indian Journal of Otolaryngology and Head & Neck Surgery. 2019;71(3):2110-3.
Idris F, Sow YL, Jamaluddin JS, Ong FM, Ibrahim S. Acute Invasive Fungal Sinusitis (Mucormycosis): Challenging Presentation with Cavernous Sinus Thrombosis and Multiple Cranial Nerves Palsy. International Medical Journal. 2019;26(6).
Bawankar P, Lahane S, Pathak P, Gonde P, Singh A. Central retinal artery occlusion as the presenting manifestation of invasive rhino-orbital-cerebral mucormycosis. Taiwan journal of ophthalmology. 2020;10(1):62.
Spellberg B, Edwards Jr J, Ibrahim A. Novel perspectives on mucormycosis: pathophysiology, presentation, and management. Clinical microbiology reviews. 2005;18(3):556-69.
Riga M, Kefalidis G, Danielides V. The role of diabetes mellitus in the clinical presentation and prognosis of Bell palsy. The Journal of the American Board of Family Medicine. 2012;25(6):819-26.
Gelston CD, Durairaj VD, Simoes EA. Rhino-orbital mucormycosis causing cavernous sinus and internal carotid thrombosis treated with posaconazole. Archives of Ophthalmology. 2007;125(6):848-9.
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