We discussed a case of a middle aged man with poorly controlled T2DM, medication non-adherence, presenting with acute/subacute headache, worsening L facial numbness & L Bell’s palsy, L eye swelling and pain, necrotic nasal and palate wound due to rhino-orbital-cerebral mucormycosis.

Rhino-orbital-cerebral mucormycosis

• Risk factors: T2DM / DKA, immunocompromised
• Symptoms: Fever, acute sinusitis, nasal congestion, purulent nasal discharge, headache, sinus pain, necrotic wounds
• Infiltration of disease -> CN palsies, cavernous venous sinus thrombosis, carotid artery involvement
• Can affect various systems: Pulmonary, GI, Cutaneous, Renal, Isolated CNS, Disseminated disease

Diagnosis

• Histopathology w/ culture confirmation
• CT (bony erosions) & MRI (intracranial / orbit / cavernous sinus)
• 1,3 beta-D-glucan (Fungitell) & Galactomannan: negative because not part of mucormycosis cell structure

Treatment

• Combo surgical + antifungal treatment
• Initial: Amphotericin B
• Step-down therapy: Posaconazole & Isavuconazole (PO or IV)