Rhinocerebral Mucormycosis Presenting As Periorbital Cellulitis with Blindness: Report of 2 Cases

Two cases of rhinocerebral mucormycosis in elderly, non-ketotic diabetics who were initially diagnosed and treated for bacterial periorbital cellulitis are reported. Both presented with a short history of periorbital pain and swelling followed rapidly by complete ophthalmoplegia and blindness. By the time of correct diagnosis, both cases were advanced with lower cranial nerve involvement, CT evidence of ophthalmic artery and cavernous sinus thrombosis and, in one, internal carotid artery invasion (demonstrated on MR angiography) with resultant cerebral infarction. One patient was treated with intravenous amphotericin B but died within a few days. The second patient had aggressive surgical resection and survived with significant residual morbidity. These cases illustrate that mucormycosis should be excluded in any diabetic patient presenting with orbital cellulitis, especially when there is early visual loss. Early aggressive treatment with surgery and antifungal agents is often successful whereas the outcome is almost universally fatal when the diagnosis is delayed.