A 22-year-old woman with insulin-dependent diabetes admitted to the hospital with a 2-day history of a progressive change in mental status as reported by her family members. This was associated with multiple episodes of epistaxis and a nonspecific headache; further system review was difficult to achieve due to the patient&#39;s psychological condition.

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Patient History

She has a known history of insulin noncompliance, as well as multiple prior DKA admissions. Her social history is important in terms of active inhaled heroin abuse.&nbsp;

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Physical Examinations

Physical examination findings revealed that she appeared ill, was lethargic, and had tachypnoea and tachycardia. Her abdominal exam revealed normal bowel sounds and diffuse tenderness with no guarding or rebound. Dry mucous membranes and dry necrotic appearing right nasal turbinates were discovered during a head and neck examination. Proptosis and ptosis were found during an examination of the right eye and orbit, ophthalmoplegia in all directions, non-reactive mydriasis, and total vision loss. A cherry-red spot was discovered during a fundoscopic examination of the right eye.

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Investigations

Laboratory tests revealed neutrophil-predominant leucocytosis, hypokalaemia, hyperglycaemia, and anion gapped metabolic acidosis. In addition, urine analysis and a drug test revealed significant ketonuria and opiates are present.&nbsp;

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An initial CT scan of the brain was performed without intravenous contrast to rule out an acute intracranial abnormality. This revealed mucosal thickening in the ethmoid sinus but no bony destruction, as well as opacification of the right-sided nasal cavity and no evidence of intracranial involvement.

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