Right lateral rectus palsy as a presenting feature of rhinocerebral mucormycosis infection in an immunocompetent teenager

Abstract

This study reports a case of an immunocompetent patient with right lateral rectus palsy secondary to
mucormycosis infection in the sphenoid and ethmoid sinuses extending to the carvenous sinus. The
patient used for this study is a healthy, well built and well nourished 14 year old girl presented with
symptom of headache of 2 weeks duration. Complaint of diplopia was made on day one of admission.
The patient’s case is a known case of asthma, but her last attack was a year ago. Metered dose inhalers
(MDI) was hardly used due to the fact that the patient is an active girl with no history of any other
illnesses or hospital admissions. Clinical examination and investigations revealed that the patient had
right lateral rectus palsy secondary to mucormycosis infection of the ethmoid, sphenoid sinuses which
extended intracranially (cavernous sinus). The investigations carried out were done through Computed
Tomography, Magnetic Imaging Resonance and biopsy of a polyp from the nasal cavity. The patient
underwent endoscopic transeptal/transphenoidal approach and excision of fungal sac with a 30 day
duration of intravenous amphotericin B. Resolution of the right lateral rectus palsy was noted
immediately on post operative day one. Even a healthy, active and an immunocompetent young person
can develop a severe fungal infection of the sinuses which extends intracranially. However, this is a
very rare occurrence and it shows that a high index of suspicion is warranted in the diagnosis of an
intracranial fungal infection in a person who only presented with a common headache