Dr.AMAN GAUR, G20405
60-year well controlled diabetic male with chronic renal failure presented with pain,proptosis & decreased vision in LE for 1 week, past history of trauma 1 month back with multiple facial fractures & hip replacement. He had VA-FC 3m, facial palsy, total ophthalmoplegia & papilledema. ENT examination WNL, scrapings from PNS had no growth. CECT consistent with orbital cellulitis. Despite iv antibiotics multiple cheek & palatal abscesses developed requiring repeated drainage, pus cultures were negative. As disease progressed,cheek biopsy done which revealed aseptate hyphae. After 2 weeks of iv amphotericin B, oral abscesses improved with no improvement in proptosis & vision became PL negative, patient refused exenteration. Repeat CECT showed B/L cavernous sinus & left internal jugular thrombosis. He later succumbed to systemic comorbidities.
Diagnosis of orbital mycosis is difficult to establish. In case of diagnostic dilemma, empirical antifungal therapy & biopsy should be considered.
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