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Images of Memorable Cases: Case 16

Module by: Herbert L. Fred, MD, Hendrik A. van Dijk

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Case_16-pres1-1.jpg Case_16-pres1-2.jpg

Case_16-pres1-3.jpg

This 33-year-old, insulin-dependent diabetic presented with fever, impaired vision, reddish-black nasal discharge, and confusion of two days’ duration. He had exophthalmos and external ophthalmoplegia on the right, along with necrosis of the right nasal mucosa and right half of the hard palate. He died 12 hours after admission.

16. Rhinocerebral mucormycosis

Autopsy demonstrated fungi occluding the right internal carotid artery, severe inflammation of the right orbit, and infarction of the right cerebral hemisphere.

Mucor organisms typically invade and multiply in arteries and veins, leading to vascular occlusion and tissue necrosis. This infection occurs almost exclusively in immunocompromised patients, especially diabetic patients with ketoacidosis.

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