Facial nerve paralysis: A case report of rare complication in uncontrolled diabetic patient with mucormycosis

Abstract

Mucormycosis is a rare opportunistic aggressive and fatal infection caused by mucor fungus. Seven types of mucormycosis are identified based on the extension and involvement of the lesion, of which the rhino orbital mucormycosis is most common in the head and neck region. Although it is widely spread in nature, clinical cases are rare and observed only in immunocompromised patients and patients with uncontrolled diabetes mellitus. Early symptoms include fever, nasal ulceration or necrosis, periorbital edema or facial swelling, paresthesia and reduced vision. Involvement of cranial nerves although not common, facial nerve palsy is a rare finding. The infection may spread through cribriform plate to the brain resulting in extensive cerebellar infarctions. Timely diagnosis and early recognition of the signs and symptoms, correction of underlying medical disorders, and aggressive medical and surgical intervention are necessary for successful therapeutic outcome.

Keywords: Diabetes mellitus; facial nerve palsy; mucormycosis.

Figure 1

Patient showing ptosis and drooping of the corner of mouth

Figure 2

Computed tomography image showing proptosis of the globe of right eye and hyperintense right maxillary sinus

Figure 3

T2-weighted magnetic resonance imaging showing bilateral maxillary and ethmoidal inflammatory sinusitis right orbit proptosis

Figure 4

Pictomicrograph showing broad, aseptate, branched hyphae