SHM Converge Scientific Abstract ePoster Gallery-Lessons From an Invasive Fungal Infection

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This case describes an 83-year-old woman with myelodysplastic syndrome and poorly controlled diabetes who developed progressive right facial pain, numbness, eye drooping, and double vision after failing two outpatient antibiotic courses for presumed sinusitis. Initial CT and MRI studies were nonspecific, and she was transferred after being treated as having optic neuritis with high-dose IV steroids.<br /><br />On arrival, she still had facial swelling, nasal congestion, and restricted eye movement. Review of her history showed average blood glucose levels around 300 mg/dL, despite a seemingly normal HbA1c that was likely falsely low because of anemia from MDS. Urgent nasal endoscopy revealed blackened, necrotic turbinates, raising concern for invasive fungal infection. She was started on amphotericin B and antibiotics and taken emergently for endoscopic debridement. Biopsy confirmed invasive mucormycosis with orbital and intracranial extension, and complete surgical removal was not possible. Because of the severity of disease and inability to control the source, she was transitioned to hospice care.<br /><br />The report highlights several key lessons: mucormycosis is a rapidly progressive angioinvasive fungal infection with very high mortality, especially in advanced disease. Major risk factors include poorly controlled diabetes and hematologic malignancies such as MDS, which can cause immune dysfunction even without obvious neutropenia. Delayed diagnosis worsens outcomes, and corticosteroids may further impair host defenses if fungal infection is not considered early. Clinicians should maintain a high suspicion for invasive fungal sinusitis in high-risk patients with persistent or worsening sinus symptoms, and prompt endoscopic evaluation and antifungal therapy are critical.

Asset Subtitle

Kashif Khan

Meta Tag

Author List Isabella Wetzka, Kashif Khan

Category Clinical Vignettes

Concept Mucormycosis

Concept Invasive Fungal Sinusitis

Concept Poor Glycemic Control

Concept Progressive Sinusitis

Concept Turbinate Necrosis

Distinguished Non-Finalist

Presenter Organization The Ohio State University Medical Center

Presenting Author Kashif Khan

Track Adult

Keywords

mucormycosis

invasive fungal sinusitis

myelodysplastic syndrome

poorly controlled diabetes

orbital extension

intracranial extension

necrotic turbinates

amphotericin B

high-dose corticosteroids

endoscopic debridement

Mucormycosis

Invasive Fungal Sinusitis

Poor Glycemic Control

Progressive Sinusitis

Turbinate Necrosis