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 Table of Contents  
CASE REPORT
Year : 2021  |  Volume : 59  |  Issue : 3  |  Page : 286-288

Case report of rhino-orbital-cerebral mucormycosis secondary to periodontal abscess presenting as exudative retinal detachment


Department of Ophthalmology, Velammal Medical College Hospital and Research Institute, Madurai, Tamil Nadu, India

Date of Submission06-Apr-2021
Date of Decision18-Apr-2021
Date of Acceptance22-May-2021
Date of Web Publication09-Sep-2021

Correspondence Address:
Dr. Elango Vidhya
Department of Ophthalmology, Velammal Medical College Hospital and Research Institute, Madurai - 625 009, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/tjosr.tjosr_36_21

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  Abstract 


A 31-year-old Type 1 diabetes mellitus presented with exudative retinal detachment due to rhino-orbital-cerebral mucormycosis secondary to a periodontal abscess developed following a tooth extraction. He received liposomal amphotericin B due to diabetic nephropathy. We report this case for the rarity in the combination of exudative retinal detachment in a case of orbital cellulitis as well for its rarest origin following a dental extraction.

Keywords: Exudative retinal detachment, liposomal amphotericin B, mucormycosis, orbital cellulitis, Type 1 diabetes mellitus


How to cite this article:
Vidhya E. Case report of rhino-orbital-cerebral mucormycosis secondary to periodontal abscess presenting as exudative retinal detachment. TNOA J Ophthalmic Sci Res 2021;59:286-8

How to cite this URL:
Vidhya E. Case report of rhino-orbital-cerebral mucormycosis secondary to periodontal abscess presenting as exudative retinal detachment. TNOA J Ophthalmic Sci Res [serial online] 2021 [cited 2021 Sep 21];59:286-8. Available from: https://www.tnoajosr.com/text.asp?2021/59/3/286/325733




  Introduction Top


Mucormycosis is a serious, relatively uncommon invasive fungal infection and one of the most aggressive and lethal invasive mycoses.[1]

Our patient had uncontrolled diabetes which is a well-known predisposing factor for mucormycosis along with spread of lesion from the palate into adjacent tissues. The initial symptoms of rhino-orbital-cerebral mucormycosis are consistent with those of sinusitis and periorbital cellulitis and include eye and/or facial pain and facial numbness followed by blurry vision. Signs and symptoms that suggest mucormycosis in susceptible individuals include, unilateral periorbital facial pain, facial cellulitis, orbital inflammation, eyelid edema, proptosis, acute ocular motility changes, nasal discharge, nasal stuffiness headache, and acute vision loss.[1],[2]


  Case Report Top


A 31-year-old male with Type 1 diabetes mellitus presented to our emergency department with complaints of inability to open his left eye since morning. He had molar tooth extraction 18 days ago with a history of intake of oral antibiotics following periodontal abscess. He was conscious, well oriented, and afebrile. A small necrotic patch was noted in the hard palate [Figure 1]. Ocular examination revealed normal right eye (OD), but left eye showed swollen erythematic lids, proptosis, conjunctival chemosis, and ptosis with complete ophthalmoplegia [Figure 2]. There was loss of sensation over the skin on the left side of the forehead and over eyelids. Visual acuity of the right eye was 6/6 with glasses and left eye was perception of light with a defective projection of rays. The pupil was 3 mm not reacting to light in his left eye. Fundus examination of the right eye was normal, while the left eye revealed an exudative retinal detachment [Figure 3]. Magnetic resonance imaging with contrast of brain, orbit, and paranasal sinuses showed orbital cellulitis, left cavernous sinus thrombosis with pansinusitis [Figure 4].
Figure 1: Intra-oral photograph showing necrotic patch in mucosa of hard palate

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Figure 2: External photograph of the eye showing ptosis and lid swelling in the left eye (a) and proptosis with conjunctival chemosis on forced retraction of the lids (b)

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Figure 3: Fundus photograph showing normal fundus in the right eye (a) and exudative retinal detachment in the left eye (b)

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Figure 4: Magnetic resonance imaging (MRI) with contrast of brain, orbit and paranasal sinuses showing edematous left optic nerve sheath complex (a) and Significant mucosal thickening in sphenoid, left maxillary and ethmoid sinuses (b,c)

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Laboratory investigations revealed HbA1c of 10.2%, blood urea of 103 mg/dl, and serum creatinine of 2.7 mg/dl. Urinary excretion of glucose and protein with budding yeast cells and bacteria were detected in urine complete analysis and microscopy. Blood culture was normal. Culture from nasal inferior turbinate yielded growth of Mucor fungus. A diagnosis of rhino-orbital-cerebral mucormycosis originating from the periodontal abscess was made. Owing to his increased renal parameters due to uncontrolled diabetes mellitus, the patient was started on liposomal amphotericin B and sinus debridement done. As the presentation of patient to the hospital was delayed and due to high virulence of the organism, the eye could not be salvaged. On follow-up, progression to phthisis bulbi was noted in the left eye.


  Discussion Top


Mucormycosis is one of the relatively uncommon, aggressive, and lethal invasive forms of fungal infection which involves the nose and paranasal sinuses of the head and neck regions.[1],[3] Mucormycosis also remains a threat to patients with uncontrolled diabetes or other predisposing systemic conditions. It manifests as rhino-cerebral, pulmonary, gastrointestinal, cutaneous, or disseminated form. The underlying conditions can influence clinical presentation and often delay diagnosis, with resultant poor outcomes.[3]

Rhino-orbital-mucormycosis is a difficult disease to treat.[4] Only one case has so far been reported, with rhino-orbital-cerebral mucormycosis complicated by serous retinal detachment.[4] The pathogenesis of exudative retinal detachment in orbital cellulitis is due to venous congestion and reactive edema across the tough fibrous sclera. The detachment is usually not extensive and there is no hole. The vitreous is clear and the treatment is that of orbital cellulitis in general.[5]

Although the incidence is rare, it may pose diagnostic and therapeutic dilemmas, especially in immunocompromised patients.[6]

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient (s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Reddy SS, Rakesh N, Chauhan P, Sharma S. Rhinocerebral mucormycosis among diabetic patients: An emerging trend. Mycopathologia 2015;180:389-96.  Back to cited text no. 1
    
2.
Hosseini SM, Borghei P. Rhinocerebral mucormycosis: Pathways of spread. Eur Arch Otorhinolaryngol 2005;262:932-8.  Back to cited text no. 2
    
3.
Sahota R, Gambhir R, Anand S, Dixit A. Rhinocerebral mucormycosis: Report of a rare case. Ethiop J Health Sci 2017;27:85-90.  Back to cited text no. 3
    
4.
Kim IT, Shim JY, Jung BY. Serous retinal detachment in a patient with rhino-orbital mucormycosis. Jpn J Ophthalmol 2001;45:301-4.  Back to cited text no. 4
    
5.
Malhotra M. Orbital cellulitis with exudative retinal detachment. Br J Ophthalmol 1957;41:317-9.  Back to cited text no. 5
    
6.
Farah E, Kalantzis G, Papaefthimiou I, Koutsandrea C, Georgalas I. Spontaneously resolved exudative retinal detachment caused by orbital cellulitis in an immunocompromised adult. Eye (Lond) 2014;28:109-10.  Back to cited text no. 6
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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