Rhino orbital mucormycosis: The new mimicker of neuro-ophthalmic lesions

Abstract

It was always challenging to start steroids in a suspected optic neuritis case with rhino-orbital mucormycosis being the differentials in the COVID era. A 27-year-old female presented with headache and fever for 1 week, along with sinusitis and both eyes (BE) blurred vision for 2 days. There was history of tingling sensation in both lower limbs with urinary retention previously. History of COVID infection 1 month back. Vision in Right Eye (RE): 20/20 and Left Eye (LE): counting fingers (CF) CF with presence of relative afferent pupillary defect (RAPD) Grade 3. Humphrey Visual field gave a picture of Junctional scotoma with ganglion cell loss noted in BE. Magnetic resonance imaging (MRI) brain with orbit gave a picture of LE optic neuritis with right ethmoidal, sphenoidal sinusitis involving orbital apex making mucor a suspect. MRI spine showed focal myelitis. Patient underwent nasal endoscopy to rule out rhino-orbital mucormycosis following which she was started on intravenous methylprednisolone (IVMP) and vision improved drastically. Hence, a diagnosis of neuromyelitis optica was made. Three doses of IVMP along with a tapering dose of oral prednisolone were given and the patient is still in follow-up with no recurrence reported till now.