Meningo-encephalo-vasculitis, optic neuritis, and thrombotic complications: About a fulminant mucormycosis in a diabetic patient

Mucormycosis is a destructive, potentially fatal, and opportunistic fungal infection caused by filamentous Mucorales which commonly affect immunocompromised hosts. This infection might take different forms such as gastrointestinal, pulmonary, cutaneous or even a disseminated form, yet the rhinocerebral localization is historically the primary presentation of the disease and most common type. It originates in the nasal mucosa owing to fungal inoculation, then it spreads through paranasal sinuses and orbits to the brain and its vessels especially the cavernous sinus, leading to thrombotic complications including arterial thrombosis. Herein, we present a case of a 35-year-old male with poorly controlled diabetes who presented with decompensated diabetes, in whom the clinical examination finds subtle signs of orbital cellulitis. The patient subsequently had worsening necrotizing orbital cellulitis which required surgical drainage of the left ethmoid along with large spectrum antibiotic therapy; this was complicated by the development of meningo-encephalo-vasculitis as well as cavernous sinus and left internal carotid thrombosis. Tissue cultures revealed evidence of Rhizopus.