PMC5378458_01
Drooping of right eyelid, drooling of saliva, and facial deviation to left side.
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A 45 year old woman with history of type 2 diabetes mellitus for 12 years and systemic hypertension for 2 years presented to us with complaints of drooping of right eyelid, drooling of saliva, and facial deviation to left side of 2 days duration (Figure 1).
Chemosis, proptosis and ophthalmoplegia of right eye.
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Nervous system examination revealed congested retinal vessels in the right optic fundus, complete ptosis and ophthalmoplegia of right eye, and chemosis and proptosis of right eye, which was suggestive of involvement of second (optic), third (oculomotor), fourth (trochlear), and sixth (abducens) cranial nerves (Figure 2).
Deviation of tongue to the right (right hypoglossal nerve palsy).
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She also developed right twelfth nerve (hypoglossal) palsy, with deviation of tongue to the right (Figure 3).
Black eschar with erosion of the hard palate on the right side.
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There was a black eschar with erosion of the hard palate on the right side (Figure 4).
Computed tomography of paranasal sinuses showing right maxillary sinusitis with spread of inflammation to infratemporal fossa.
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Contrast-enhanced computed tomography of paranasal sinuses revealed right maxillary and right ethmoid sinusitis, with inflammation extending to zygomatic, pterygoid spaces, and infratemporal fossa and cavernous sinus (Figure 5).
Rhizopus growth in Sabouraud's dextrose agar.
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Culture of the debrided tissue from sinus mucosa yielded rhizopus growth in Sabouraud's dextrose agar (Figure 6), and microscopy showed filamentous branching aseptate hyphae with sporangia (Figure 7).
Filamentous branching aseptate hyphae with sporangia.. Note: Magnification: 40x.
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Culture of the debrided tissue from sinus mucosa yielded rhizopus growth in Sabouraud's dextrose agar (Figure 6), and microscopy showed filamentous branching aseptate hyphae with sporangia (Figure 7).
Angioinvasion by fungal hyphae (arrow).
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Histopathological examination confirmed the presence of angioinvasion by fungal hyphae (Figure 8).