Premium
Mucormycosis is a rare etiology of ophthalmoplegia: How to diagnose and to manage it, about one exceptional case
Author(s) -
LAGENAITE C
Publication year - 2013
Publication title -
acta ophthalmologica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.534
H-Index - 87
eISSN - 1755-3768
pISSN - 1755-375X
DOI - 10.1111/j.1755-3768.2013.s099.x
Subject(s) - medicine , mucormycosis , ptosis , diplopia , surgery , etiology , context (archaeology) , thrombosis , cavernous sinus , pathology , paleontology , biology
Purpose Mucormycosis is a rare opportunist infection,characterized by a high mortality rate occurring in immunodeficient patient population.Its rhino‐cerebral form may be complicated by neuro‐ophthalmological and orbital symptomatology. Methods We report a case of a 57 years old woman, referring because of diplopia associated with a diabetic ketoacidosis .Ocular examination revealed a complete left ophthalmoplegia. Magnetic resonance imaging highlighted a cavernous sinus thrombosis associated with ipsilateral pansinusitis. In this context, mucormycosis diagnosis is discussed and confirmed by anatomopathology analysis after sinusal biopsy.The follow‐up is exceptional in its ophthalmological complications despite antifungal agents and anticoagulant therapy.We observed consecutively a left central retinal artery occlusion (CRAO) then a contralateral central retinal veinous occlusion,and finally a left neovascular glaucoma. Results Mucormycosis is a fungal opportunist infection that must be very early diagnosed.This pathology is caracterized by sinusal infiltration, necrosis, and bony walls damage. Medical treatment by anti‐fungal agents alone, can not contain it. It must be associated with a wide and repeated surgical debridement of necrotic tissue. Symptomatic ocular treatment (anti‐VEGF, Laser) is needed in order to preserve visual function and anatomical prognosis.Indeed, the extension along blood vessels walls leads to thrombosis and necrosis, that is resistant to systemic therapy. Our patient is still alive after a follow‐up of 24 months. Conclusion This case illustrates a serious multidisciplinary pathology,that is very difficult to control.The ocular signs were predominant but revealed a large rhino‐cerebral infiltration.