A middle-aged woman with newly diagnosed diabetes mellitus (haemoglobin A1c: 12.39%) presented with left eye complete ptosis, facial pain for 5 days, and preceding fever for 3 days with no rhinitis or sinusitis symptoms. On presentation, the patient was afebrile.
Clinical Examinations
Tenderness was noted in all of the sinuses on the left side. The left eye had complete internal and external ophthalmoplegia, with no left eye direct light reflex and visual acuity of 6/36. The movements and vision of the right eye were normal. The remainder of the neurological exam was within normal limits.
At room temperature, the pulse rate was 78 beats per minute, blood pressure was 124/80 mm Hg, and oxygen saturation was 98%. The systemic examination was unremarkable, and no clinical evidence of ketoacidosis was found.
The left ethmoid, maxillary, and frontal sinuses were completely opacified on a CT paranasal sinus. An MRI brain revealed an acute infarct in the left parietooccipital lobe, a subperiosteal abscess in the superomedial extraconal aspect of the left orbit and thickening and perineural enhancement of the left optic nerve.
FESS was performed on an emergency basis due to orbital apex syndrome, as she fell into group ‘A' of endonasal surgery indications4 and had unhealthy, polypoidal mass and slough in the maxillary, anterior and posterior ethmoid sinuses, pus in the frontal sinus, and polypoidal mucosa in the sphenoid sinus.
Histopathological examination of the biopsy sample from the ethmoid sinus revealed fungal colonies of broad aseptate hyphae at an obtuse angle with periodic acid–Schiff stain, consistent with mucormycosis. Mucormycosis was confirmed by the fungal culture of the sample obtained after sinus debridement in FESS (Rhizopus species).
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