Sudden vision loss caused by rhino-orbital zygomycosis in diabetic patients: case series

Abstract

Rhino-orbital zygomycosis is a life-threatening fungal infection generally occurring in patients with an underlying disorder, such as diabetes mellitus with ketoacidosis or with immunocompromising factors, although it may rarely appear in healthy individuals. The study has been undertaken to discuss the clinical presentation, pathogenesis, diagnostic work up and management of this rapidly progressive disease. Four male patients having uncontrolled diabetes and presenting with signs and symptoms of rhino-orbital zygomycosis were studied to illustrate the serious nature of the disease. All the four patients had rapidly deteriorating vision loss either unilateral or bilateral along with other nasal and orbital signs and symptoms. All the patients were put on liposomal amphotericin B and underwent orbital exenteration and pansinusectomy. One patient died, while the other three were successfully treated. Early diagnosis is critical in the prevention of morbidity and mortality associated with the disease. There is need for a high index of clinical suspicion in immunocompromised patients. Timely medical-surgical treatment proves extremely important for prognosis.

Diabetes, COVID 19 and mucormycosis

“…According to additional research, people with uncontrolled diabetes experience faster unilateral and bilateral vision loss worsening [14].…”

Rare Cellulite On Mucormycosis

“…Surgical debridement of the foci of necrosis must be carried out early and guided by the extemporaneous examination [9]. The functional and vital prognosis of this condition is bad with a mortality rate of 20 to 50% of cases [10]. Survival depends on the rapid response time (76% for treatment before 7 days and 40% after two weeks) and on the combination of surgical debridement with antibiotic therapy [3] [10].…”

Neurologic infections in diabetes mellitus

“…Among diabetic patients, rhino-orbital-cerebral disease is the most common clinical syndrome and may involve the nose, sinuses, orbit, or brain singly or in various combinations (Roden et al, 2005;Sun and Singh, 2011;Petrikkos et al, 2012). Early rhino-orbital-cerebral disease may present as facial pain, with or without diabetic ketoacidosis, or treatmentresistant sinusitis or orbital cellulitis (Chander et al, 2009). Early rhino-orbital-cerebral disease may present as facial pain, with or without diabetic ketoacidosis, or treatmentresistant sinusitis or orbital cellulitis (Chander et al, 2009).…”

“…Early rhino-orbital-cerebral disease may present as facial pain, with or without diabetic ketoacidosis, or treatmentresistant sinusitis or orbital cellulitis (Chander et al, 2009). Manifestations of orbital involvement include pain, proptosis, chemosis, visual loss from optic nerve involvement, or diplopia from dysfunction of the oculomotor, trochlear, or abducens nerves (or direct compromise of the related muscles by infection) (Chander et al, 2009;Sun and Singh, 2011). Manifestations of orbital involvement include pain, proptosis, chemosis, visual loss from optic nerve involvement, or diplopia from dysfunction of the oculomotor, trochlear, or abducens nerves (or direct compromise of the related muscles by infection) (Chander et al, 2009;Sun and Singh, 2011).…”