A rare case report of mucormycosis presenting as cranial nerve palsies in a patient with diabetes and iatrogenic cushing syndrome.

RATIONALE

Mucormycosis is a rare opportunistic fungal infection caused by mucormycetes, primarily affecting immunocompromised individuals such as diabetic patients. Cranial nerve involvement, including facial and abducens nerve palsies, is an uncommon but serious complication.

PATIENT CONCERNS

We present the case of a 47-year-old female with uncontrolled diabetes and iatrogenic Cushing's syndrome who developed mucormycosis complicated by right-sided facial weakness (upper motor neuron type) and abducens nerve palsy (lower motor neuron type). She presented with a 1-month history of right-sided facial swelling, headache, and earache, and a 6-day history of sudden-onset facial weakness. Examination revealed preserved eye closure and forehead wrinkling, with a deficit in right eye abduction. Black eschar was noted in the intranasal and hard palate areas.

DIAGNOSES

Imaging (computed tomography paranasal sinuses and magnetic resonance imaging) and histopathological confirmation established the diagnosis.

INTERVENTIONS

Treatment included amphotericin B and 2 surgical debridements following otorhinolaryngology consultation.

OUTCOME

Patient's facial swelling improved during hospital stay, and abduction deficit resolved on 1-month follow-up.

LESSONS

This case highlights the critical need for early recognition and multidisciplinary management of mucormycosis, particularly in diabetic or immunocompromised patients presenting with cranial nerve deficits. Prompt diagnosis and treatment are vital to reduce morbidity and improve outcomes.