Disguised Threat: Rhino-Orbital Mucormycosis Masquerading as Acute Dacryocystitis

TL;DR

A rare case of mucormycosis was mistaken for a common eye infection, highlighting the need for early diagnosis in high-risk patients.

Contribution

This case report highlights the diagnostic challenge of mucormycosis masquerading as acute dacryocystitis in immunocompromised patients.

Findings

A diabetic patient initially diagnosed with acute dacryocystitis was later found to have invasive mucormycosis.

Delayed diagnosis led to significant orbital involvement despite prompt treatment initiation.

The case underscores the importance of considering mucormycosis in immunocompromised patients unresponsive to standard therapy.

Abstract

Mucormycosis is an aggressive, life-threatening fungal infection predominantly affecting immunocompromised individuals. It typically manifests as rhino-orbital or rhino-cerebral disease. However, rarely, its initial presentation may closely resemble an innocuous condition like acute dacryocystitis, which is prone to result in higher morbidity rates. Herein, we report a case of a 52-year-old diabetic patient who presented with symptoms suggestive of acute dacryocystitis. Broad-spectrum antibiotics were started, but the patient did not improve with therapy. Further investigations, including imaging and biopsy, unraveled invasive mucormycosis. Prompt surgical debridement and antifungal therapy were initiated, but the delayed diagnosis culminated in significant orbital involvement. A high index of clinical suspicion is warranted for mucormycosis in patients with risk factors such as diabetes or immunosuppression who present with dacryocystitis and are unresponsive to standard treatment. Early diagnosis and aggressive intervention play a pivotal role in improving patient outcomes in this condition.

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