Orbital Apex Syndrome as initial presentation of Rhino-orbital-cerebral Mucormycosis in an immunocompromised patient

Abstract

We report a case of a 47-year-old with underlying poor controlled diabetes mellitus, presented with acute onset of right orbital apex syndrome few hours after dental extraction done. The right orbital apex syndrome was preceded by right facial swelling and tooth pain for 5 days which did not subside with antibiotics. Nasoendocopy found fungal spores, and biopsy sample cultured Rhizopus arrhizus. Computed tomography of brain, orbit and paranasal sinuses showed acute intraparenchymal and subdural hemorrhage of right frontal lobe with right maxillary sinusitis and bony erosion. Patient was diagnosed with rhino-orbito-cerebral mucormycosis. He was immediately started on intravenous antibiotics and antifungal however he refused for further surgical intervention. He unfortunately passed away 3 weeks later. Mucormycosis infection is fatal and early detection and management are crucial to improve prognosis.