Abstract
A 70-year-old female with poorly controlled diabetes developed sudden visual loss, ptosis and complete ophthalmoplegia of the right eye. Funduscopic examination showed the pale retina and the cherry red spot in the right eye. Fluorescein angiography and indocyanine green angiography demonstrated the absence of retinal arterial filling and choroidal perfusion in the right eye even 20 minutes after injecting the dye. The patient was diagnosed with right ophthalmic artery occlusion. Computed tomography (CT) showed diffuse mucosal thickening in the right ethmoidal sinus. Based on the clinical findings and endoscopic biopsy result, mucormycosis was confirmed. Amphotericin B (40 mg/day) and ceftriaxone (2 g/day) were intravenously administered. Despite the improvement of the right ethmoidal sinusitis and the right proptosis, the patient deteriorated into a comatose state after 19 days of systemic amphotericin B therapy. Although the previous CT showed no cerebral aneurysm, a repeated CT showed newly developed posterior communicating artery aneurysm and the subarachnoid hemorrhage. Despite the amphotericin B treatment and the improvement of the sinusitis, mucormycosis could cause sudden cerebral aneurysm rupture and subarachnoid hemorrhage resulting in coma.
Highlights
Mucormycosis is a fungal infection caused by the family Mucoraceae-pathogenic genera Rhizopus, Absidia and Mucor [1]
We report a rare case of rhino-orbito-cerebral mucormycosis complicated with an ophthalmic artery occlusion followed by sudden onset subarachnoid hemorrhage
The patient was diagnosed with right ophthalmic artery occlusion
Summary
Mucormycosis is a fungal infection caused by the family Mucoraceae-pathogenic genera Rhizopus, Absidia and Mucor [1]. Infections typically occur in immunocompromised patients with diabetic ketoacidosis, lymphoma, leukemia, corticosteroid treatment, radiation therapy, chemotherapy, myelodysplastic syndrome, aplastic anemia and the acquired immunodeficiency syndrome [2]. Rhino-orbito-cerebral mucormycosis is a rare opportunistic fungal infection that is potentially fatal. We report a rare case of rhino-orbito-cerebral mucormycosis complicated with an ophthalmic artery occlusion followed by sudden onset subarachnoid hemorrhage
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