Orbitocerebral Mucormycosis in a Patient With Central Nervous System Lymphoma

A 61-year-old man with well-controlled diabetes mellitus type 2, cirrhosis from hepatitis C, alcohol abuse, and portal hypertension presented with painful vision loss and left orbital swelling. Imaging showed diffuse orbital, perineural, and pachymeningeal inflammation. He was initially diagnosed with neurosarcoidosis. However, cerebrospinal fluid analysis revealed central nervous system lymphoma, and lacrimal gland biopsy showed fungal organisms consistent with mucormycosis. The authors describe a case of Mucorales infection lacking sinonasal involvement and discuss the differential diagnosis and management of patients presenting with orbital and central nervous system inflammation from this uncommon fungal infection. Accepted for publication August 1, 2018. Supported in part by National Eye Institute Vision Core Grant P30EY010608 and the Hermann Eye Fund. No authors declare no conflicts of interest. Previously presented in part at the North American Neuro-Ophthalmology Society 43rd Annual Meeting on April 1–6, 2017 in Washington, DC. Address correspondence and reprint requests to Ore-ofe O. Adesina, M.D., Robert Cizik Eye Clinic, 6400 Fannin St, Suite 1800, Houston, TX 77030. E-mail: ore-ofeadesina@cizikeye.org © 2018 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.