PMC7497822_01
MRI showing altered heterogeneously enhanced oedema involving the left periorbital soft tissue, including the left eyelid, with left proptosis and sinusitis.
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F1
Magnetic resonance imaging (MRI) and contrast enhanced magnetic resonance imaging (CEMRI) showed altered heterogeneously enhanced oedema involving the left periorbital soft tissue, including the left eyelid, with left proptosis and sinusitis (Fig. 1, Table 2).
10 % KOH mount showing branched septate hyphae with characteristic dichotomous branching, along with a few broad non-septate hyphae (under 400 X magnification).
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F2
Magnetic resonance imaging (MRI) and contrast enhanced magnetic resonance imaging (CEMRI) showed altered heterogeneously enhanced oedema involving the left periorbital soft tissue, including the left eyelid, with left proptosis and sinusitis (Fig. 1, Table 2). In the microbiology laboratory, 10 % KOH mount analysis was performed, which initially showed branched septate hyphae of 3-6 microm in diameter with characteristic dichotomous branching, along with a few broad non-septate hyphae (Fig. 2).
LPCB mount showing both hyphae with phialides and broad non-septate hyphae with sporangium and rhizoids (under 400 X magnification).
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F3
A lactophenol cotton blue (LPCB) mount of this mixed growth showed both septate hyphae with phialides, and broad non-septate hyphae with sporangium and rhizoids (Fig. 3).
Subculture on SDA showing greenish velvety growth in the slant on the left and cottony white dense growth in the slant on the right.
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F4
The other slant showed cottony white dense growth after 8-10 days of incubation (at 25  C) (Fig. 4).
Histopathological examination showing many acute angle branching septate hyphae of aspergillus (blue arrow) along with a few aseptate ribbon-like hyphae of mucor fungus (red arrow). (Under 1000X magnification).
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F5
It also showed both acute angle branching septate hyphae with spores and ribbon-like aseptate broad hyphae (Fig. 5).
After 2.5 months of treatment another MRI was carried out, which showed a significant decrease in the soft tissue problems. Fluid noted in the sphenoid sinus was likely postoperative collection.
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F6
Fluid noted in the sphenoid sinus was labelled as likely postoperative collection (Fig. 6).