Facial nerve paralysis: A case report of rare complication in uncontrolled diabetic patient with mucormycosis

Abstract

Mucormycosis is a rare opportunistic aggressive and fatal infection caused by mucor fungus. Seven types of mucormycosis are identified based on the extension and involvement of the lesion, of which the rhino orbital mucormycosis is most common in the head and neck region. Although it is widely spread in nature, clinical cases are rare and observed only in immunocompromised patients and patients with uncontrolled diabetes mellitus. Early symptoms include fever, nasal ulceration or necrosis, periorbital edema or facial swelling, paresthesia and reduced vision. Involvement of cranial nerves although not common, facial nerve palsy is a rare finding. The infection may spread through cribriform plate to the brain resulting in extensive cerebellar infarctions. Timely diagnosis and early recognition of the signs and symptoms, correction of underlying medical disorders, and aggressive medical and surgical intervention are necessary for successful therapeutic outcome.

Rhino-orbito-cerebral mucormycosis in patients with uncontrolled diabetes: A case series

“…CT scans of patients with rhino-orbito-cerebral mucormycosis can show simple sinusitis, but a negative CT scan does not necessarily rule out mucormycosis. MRI is more sensitive than CT in detecting orbital and central nervous system involvements [ 8 ].…”

“…Posaconazole is an alternate drug of choice if the patient is resistant to amphotericin B, or it can be used as a combination therapy with liposomal amphotericin B. Amphotericin B lipid complexes act primarily as a cytochrome P-450 3A4 [ 9 , 11 ]. The combination of medical and surgical management increases the rate of survival from 57.5%–78% compared to only medical treatments [ 10 ].…”

A Rare Case of Facial Palsy Due to Mucormycosis

“…Very few cases have been reported in the tympanic bone; although rhino-cerebral involvement has been observed quite frequently [3] [4] [6]- [10]. Mucormycosis causing isolated facial nerve paralysis is extremely rare.…”

“…In two cases, it spread from nasopharynx [6] [7], and in the rest from the paranasal sinuses [3] [4] [8]- [10]. The clinical features of mucormycosis are dependent on the site of involvement.…”

Rhinocerebral mucormycosis: a case series

“…1 It rarely affects otherwise healthy population. About 70% rhinocerebral cases are found in diabetes mellitus with ketoacidosis.…”