Case History:

67 yo Male diagnosed with type 2 diabetes, A1c=13.0, PMH of septoplasty to correct deviated septum. Presents with 1 month of worsening headache, left sided blindness, and hemifacial paralysis. NE biopsy revealed diagnosis:

What is the diagnosis?

A. Aspergillosis
B. Mucormycosis
C. Fusariosis
D. Bacterial rhinosinusitis

Correct Answer: B. Mucormycosis

Discussion: 

Fungal elements are seen invading sinus tissue. The hyphae are broad and ribbon-like. Taken together with clinical symptoms, surgical history, and A1c result, this is enough to diagnose as mucormycosis. While ~50% of mucormycosis cases present with bacterial co-infection, the Mucorales is more aggressive and can cause permanent deafness, blindness or death. Mucorales can be angioinvasive leading to a poor prognosis without early diagnosis and treatment.

Case contributed by: Filipe Cerqueira, Ph.D., Assistant Professor, Laboratory Medicine