Abstract
A 75-year-old man with type 2 diabetes mellitus presented with complete loss of vision in his right eye and severe headaches for the past 24 hours. He had been treated for suspected giant cell arteritis (GCA) with high-dose corticosteroids which were being tapered to stop after an inconclusive right temporal artery biopsy and an erythrocyte sedimentation rate (ESR) value of 8. His current acute presentation, however, raised further concern for partially treated GCA and precipitated treatment with pulsed methylprednisolone. The patient, taking metformin, developed diabetic ketoacidosis and was transferred to the intensive care unit where a swollen, painful right eye with chemosis and complete ophthalmoplegia was subsequently revealed to be secondary to cavernous sinus thrombosis. Rhino-orbital skin necrosis with positive samples for the organism Rhizopus on eventual orbital exenteration revealed angioinvasive fungal infection, mucormycosis, to be the cause. We discuss here the lessons learnt, and how best to treat a susceptible cohort within our ageing western population.
References
Jul 1, 1994·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·R D AdamG Comerci
Jun 14, 2000·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·D P KontoyiannisK V Rolston
Jul 16, 2005·Clinical Microbiology Reviews·Brad SpellbergAshraf Ibrahim
Aug 5, 2005·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·Maureen M RodenThomas J Walsh
Jul 11, 2006·Postgraduate Medical Journal·C DaviesA Shandall
Mar 5, 2008·Dento Maxillo Facial Radiology·N U HalilogluI Erden
Oct 28, 2009·Auris, Nasus, Larynx·Kathrin ScheckenbachMartin Wagenmann
Apr 8, 2010·Rheumatology·Bhaskar DasguptaUNKNOWN BSR and BHPR Standards, Guidelines and Audit Working Group
Sep 21, 2010·Clinical Medicine : Journal of the Royal College of Physicians of London·Bhaskar Dasgupta, UNKNOWN Giant Cell Arteritis Guideline Development Group
Jan 25, 2012·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·Ashraf S IbrahimDimitrios P Kontoyiannis
Jan 25, 2012·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·George PetrikkosDimitrios P Kontoyiannis
Nov 3, 2012·Médecine et maladies infectieuses·A ToumiM Chakroun
Jan 31, 2014·Clinical Microbiology and Infection : the Official Publication of the European Society of Clinical Microbiology and Infectious Diseases·G PetrikkosM Drogari-Apiranthitou
Feb 22, 2016·Infectious Disease Clinics of North America·Dimitrios Farmakiotis, Dimitrios P Kontoyiannis