Mucormycosis with extensive cranial nerve involvement as the first presentation of diabetes mellitus: A case report

Abstract

Mucormycosis, a rare fungal infection, mainly affects individuals with diabetes mellitus and those who were immunocompromised and has a high mortality rate. Its most common presentation is similar to that of acute bacterial sinusitis with symptoms of nasal congestion, headache, and fever. The involvement of multiple cranial nerves in mucormycosis was rarely reported in the literature and indicates severe disease. Herein, we report the case of a 56-year-old man who was referred to the ophthalmology outpatient clinic for facial nerve palsy. He was treated with systemic steroids for 10 days with no improvement. On examination, he had a loss of vision and a frozen orbit due to involvement of cranial nerves II, III, IV, V, VI, and VII. An extensive workup revealed a hemoglobin A1C of 10%. However, he was never diagnosed with diabetes mellitus previously and denied any of the classical symptoms of diabetes mellitus. He underwent ethmoidectomy, maxillectomy, and drainage of an intraorbital abscess after appropriate imaging studies. Histopathology confirmed the diagnosis of mucormycosis, and the patient was started on systemic amphotericin B. This case emphasizes the importance of screening for diabetes mellitus. Early recognition of underlying diabetes mellitus in this patient may have prevented the development of mucormycosis along with its devastating complications.

Extra-axial cranial nerve enhancement: a pattern-based approach

“…Finally, fungal infections, such as aspergillosis and mucor mycosis, are particularly prone to perineural involvement; in particular, mucor mycosis presents with a thin and unilateral pattern of cranial nerve enhancement; however, its pathogenesis is not well understood [ 52 ] ; it could be possibly related to meningeal enhancement or to the presence of phlegmonous soft tissue along the cranial nerve [ 40 ]. Infection commonly begins in the paranasal sinuses and then spreads in the intracranial compartment along nerves and adjacent structures, being the CN II and the CNs, into the cavernous sinus [ 53 ].…”