Balch K, Phillips P H, Newman N J
Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia, USA.
J Neuroophthalmol. 1997 Sep;17(3):178-82.
A 66-year-old woman with a history of non insulin-dependent diabetes mellitus, hypertension, and hypothyroidism presented with a painless orbital apex syndrome without any sign of orbital cellulitis or acute systemic disease. Her blood glucose was mildly elevated, but there was no diabetic ketoacidosis. Neuroimaging revealed only mild sinus disease. Transnasal sphenoidal mucosal biopsy showed an inflammatory mass with cellular atypia on frozen sections, suggesting squamous cell carcinoma. 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. Examination 3 months after presentation revealed complete resolution of her ocular motility deficits and partial resolution of her optic neuropathy. Mucormycosis should be suspected in any case of orbital apex syndrome, especially in the diabetic patient.
一名66岁女性，有非胰岛素依赖型糖尿病、高血压和甲状腺功能减退病史，出现无痛性眶尖综合征，无眼眶蜂窝织炎或急性全身性疾病迹象。她的血糖轻度升高，但无糖尿病酮症酸中毒。神经影像学仅显示轻度鼻窦疾病。经鼻蝶窦黏膜活检在冰冻切片上显示有细胞异型性的炎性肿块，提示鳞状细胞癌。然而，对永久切片的复查显示有与毛霉菌病相符的宽而无隔膜的菌丝。患者接受了为期3个月的静脉注射两性霉素B治疗，未进行进一步手术。就诊3个月后的检查显示其眼球运动障碍完全缓解，视神经病变部分缓解。在任何眶尖综合征病例中，尤其是糖尿病患者，都应怀疑毛霉菌病。
