A 61-year-old male with interstitial lung disease status post left lung transplant on immunosuppression develops worsening left facial and periorbital swelling after dental cleaning. Symptoms are unresponsive to oral antibiotics and after three days the patient is examined by ophthalmology and otolaryngology. He is found to have slight restriction of extraocular movements and chemosis of the affected eye. His visual acuity is noted to be 20/40 in the right eye and 20/50 in the left eye, there is no APD, and color plates are full on the right and 10/11 on the left. His fiberoptic nasopharyngeal exam is unremarkable. A CT of the face is performed and demonstrates extensive left sided sinusitis as well as a possible left orbital cellulitis with subperiosteal phlegmon. The patient is started on broad spectrum IV antibiotics and isavuconazium. After three days of treatment and serial examination he is noted to have necrosis of the hard palate and undergoes extensive sinus debridement for concern for mucormycosis, which is confirmed on pathology. He is started on liposomal amphotericin B, posaconazole and micafungin, but continues to deteriorate despite additional surgical debridement. Nine days after presentation he undergoes exenteration of the left orbit and initially stabilizes on clinical exam. However, over the ensuing days the patient experiences episodes fevers, hypothermia and hypotension. Nineteen days after presentation the patient expires.
Presentation Date: 08/08/2019
Issue Date: 08/01/2020