Acute ophthalmoplegia

Mucormycosis is an aggressive fungal infection caused by ubiquitous mould genera (such as Mucor and Rhizopus) that cause furry coatings on food. In healthy people, the immune system prevents infection from inhaled spores; however in immunocompromised people, the mould can grow rapidly. Poorly contro...

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Bibliographic Details
Published in:The Lancet (British edition) 2003-03, Vol.361 (9361), p.930-930
Main Authors: Brotman, Daniel J, Taege, Alan, Ruggieri, Paul, Kinkel, R Philip
Format: Article
Language:English
Subjects:
Aged
Biological and medical sciences
Case reports
Chelation
Disease
Extremities
Fatal Outcome
Human mycoses
Humans
Immune system
Infectious diseases
Lesions
Magnetic Resonance Imaging
Male
Malnutrition
Medical sciences
Mucor
Mucormycosis - complications
Mucormycosis - diagnosis
Muscles
Mycoses
Mycoses of the nervous system
NMR
Nose
Nuclear magnetic resonance
Oculomotor disorders
Ophthalmology
Ophthalmoplegia
Ophthalmoplegia - etiology
Rhizopus
Sinuses
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Summary:Mucormycosis is an aggressive fungal infection caused by ubiquitous mould genera (such as Mucor and Rhizopus) that cause furry coatings on food. In healthy people, the immune system prevents infection from inhaled spores; however in immunocompromised people, the mould can grow rapidly. Poorly controlled diabetes, particularly with acidosis, carries a particularly high risk for mucormycosis. In this patient, the injury to his face may have facilitated invasion. Patients receiving iron chelation, those with haematological malignancies, neutropenia, and severe malnutrition are also vulnerable1,2. Treatment of mucormycosis requires aggressive surgical debridement. Death is almost invariable when complete resection is not possible3. Antifungals serve an adjunctive role. Our patient's presentation was consistent with bilateral cavernous sinus involvement (or extensive orbital apex involvement) by the fungus4. All nerves controlling extraocular muscles, and the ophthalmic division of the trigeminal nerve pass through the cavernous sinus. The optic nerves and optic chiasm are immediately next to the cavernous sinus. The proximity of these structures allows for ophthalmoplegia, vision loss, pupillary defects, and loss of corneal reflexes from a small lesion. A massive pontine lesion might produce similar deficits, but would affect motor function to the extremities. Mucormycosis should be considered in a diabetic patient with acute cranial nerve defects that fail to resolve with correction of hyperglycaemia. Necrotic eschar replacing nasal mucosa strongly supports this diagnosis.
ISSN:0140-6736
1474-547X
DOI:10.1016/S0140-6736(03)12776-6