PAINLESS ORBITAL APEX SYNDROME FROM MUCORMYCOSIS

A 66-year-old woman with a history of non-insulin-dependent diabetes m ellitus, hypertension, and hypothyroidism presented with a painless or bital apex syndrome without any sign of orbital cellulitis or acute sy stemic disease. Her blood glucose was mildly elevated, but there was n o diabetic ketoacidosis. Neuroimaging revealed only mild sinus disease . Transnasal sphenoidal mucosal biopsy showed an inflammatory mass wit h cellular atypia on frozen sections, suggesting squamous cell carcino ma. However, review of the permanent sections showed broad, nonseptate hyphae consistent with mucormycosis. The patient was treated with a 3 -month course of intravenous amphotericin B and no further surgery. Ex amination 3 months after presentation revealed complete resolution of her ocular motility deficits and partial resolution of her optic neuro pathy. Mucormycosis should be suspected in any case of orbital apex sy ndrome, especially in the diabetic patient.