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Abstract
Importance: This report describes a new magnetic resonance finding in acute fulminant invasive fungal sinusitis that may aid in the diagnosis of orbital involvement. Observations: The charts of two patients who presented with diabetic ketoacidosis and suspected acute fulminant invasive fungal sinusitis were retrospectively examined. Medical and surgical records, imaging studies, and histopathology specimens were reviewed. The two patients, a 58-year old female and 54-year-old male each had a contrast-enhanced magnetic resonance of the paranasal sinuses and orbits. Acute fulminant invasive fungal sinusitis with suspected orbital involvement was associated with focal loss of contrast enhancement of the inferior rectus muscle and adjacent orbital tissues. Fungal involvement of the inferior rectus muscle was confirmed on pathologic evaluation in both patients after exenteration. Conclusions and relevance: The finding of loss of contrast enhancement of an extraocular muscle on magnetic resonance may increase diagnostic confidence of orbital involvement in the setting of acute fulminant invasive fungal sinusitis and help guide surgical planning.
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