Unusual Case of Mucormycosis-Associated Central Retinal Artery Occlusion without Orbital Involvement: A Case Report
,
Abstract
Mucormycosis is an invasive fungal infection caused by fungi of the order Mucorales. It can lead to significant mortality and morbidity in immunocompromised and diabetic patients. We herein present a patient with untreated type 2 diabetes who was admitted for acute progressive vision loss. Following diagnostic findings, she was diagnosed with mucormycosis that directly infiltrated the cerebral arteries, resulting in blindness in her left eye. This is an uncommon presentation of mucormycosis, as it led to arterial invasion without involving the orbit. This case underscores the significance of promptly diagnosing mucormycosis in susceptible individuals to avert catastrophic outcomes.
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[2] Ribes JA, Vanover-Sams CL, Baker DJ. Zygomycetes in human disease. Clin Microbiol Rev. 2000;13(2):236-301. https://doi.org/10.1128/CMR.13.2.236
[3] Gale GR, Welch AM. Studies of opportunistic fungi. I. Inhibition of Rhizopus oryzae by human serum. 1961. https://
doi.org/10.1097/00000441-196105000-00008
[4] Ferguson BJ. Mucormycosis of the nose and paranasal sinuses. Otolaryngol Clin North Am. 2000;33(2):349-65. https://doi.org/10.1016/S0030-6665(00)80010-9
[5] Greenberg RN, Scott LJ, Vaughn HH, Ribes JA. Zygomycosis (mucormycosis): emerging clinical importance and new
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[6] Roden MM, Zaoutis TE, Buchanan WL, Knudsen TA, Sarkisova TA, Schaufele RL, et al. Epidemiology and outcome of
zygomycosis: a review of 929 reported cases. Clin Infect Dis. 2005;41(5):634-53. https://doi.org/10.1086/432579
[7] Jeong W, Keighley C, Wolfe R, Lee WL, Slavin M, Kong D, et al. The epidemiology and clinical manifestations of
mucormycosis: a systematic review and meta-analysis of case reports. Clin Microbiol Infect. 2019;25(1):26-34. https://doi.org/10.1016/j.cmi.2018.07.011
[8] Harrill WC, Stewart MG, Lee AG, Cernoch P. Chronic rhinocerebral mucormycosis. Laryngoscope. 1996;106
(10):1292-7. https://doi.org/10.1097/00005537-199610000-00024
[9] Pakdel F, Mardani M, Salehi M, Khodavaisy S, Tabari A. Practice guideline on prevention, diagnosis, and treatment
of rhino-orbito-cerebral mucormycosis in the COVID-19 area: a consensus of Iranian experts. Arch Clin Infect Dis.
2022;17:e127072. https://doi.org/10.5812/archcid-127072
[10] Dong N, Jordan AE, Shen X, Wu X, Guo X, Zhao H, et al. Rhino-Orbital Cerebral Mucormycosis in a Patient With
Diabetic Ketoacidosis: A Case Report and Literature Review. Front Neurol. 2022;13:815902. https://doi.org/10.3389/
fneur.2022.815902
[11] Sreshta K, Dave TV, Varma DR, Nair AG, Bothra N, Naik MN, et al. Magnetic resonance imaging in rhino-orbital-cerebral mucormycosis. Indian J Ophthalmol. 2021;69(7):1915-27. https://doi.org/10.4103/ijo.IJO_1439_21
[12] Manjunath KS, Shivaswamy S, Kulkarni JD, Kenkare Venkatachalaiah R. Rhino-orbito-cerebral mucormycosis
(ROCM) with internal carotid artery stenosis in a diabetic patient with caries tooth and oroantral fistula. BJR Case Rep.
2016;2(2):20150447. https://doi.org/10.1259/bjrcr.20150447
[13] Agrawal A, Tripathi PS, Shukla P, Nigam P, Kheti P. Intracranial manifestations of rhinocerebral mucormycosis: a pictorial essay. Egypt J Radiol Nucl Med. 2022;53(1):86. https://doi.org/10.1186/s43055-022-00765-5
[14] Safder S, Carpenter JS, Roberts TD, Bailey N. The “Black Turbinate” Sign: An Early MR Imaging Finding of Nasal
Mucormycosis. AJNR Am J Neuroradiol. 2010;31(4):771. https://doi.org/10.3174/ajnr.A1808
[15] Chandran V, Swee Ying C, Hosnaliza SI, Nasaruddin RA, Che Hamzah J. Rhino-Orbital Mucormycosis Presenting As Orbital Apex Syndrome With Central Retinal Artery Occlusion: A Rare Phenomenon. Cureus. 2024;16(11):e73400. https://doi.org/10.7759/cureus.73400
[16] Patil A, Mohanty HS, Kumar S, Nandikoor S, Meganathan P. Angioinvasive rhinocerebral mucormycosis with complete unilateral thrombosis of internal carotid artery-case report and review of literature. BJR Case Rep. 2016;2(2). https://doi.org/10.1259/bjrcr.20150448
[17] Bawankar P, Lahane S, Pathak P, Gonde P, Singh A. Central retinal artery occlusion as the presenting manifestation
of invasive rhino-orbital-cerebral mucormycosis. Taiwan J Ophthalmol. 2020;10(1):62-5. https://doi.org/10.4103/tjo.
tjo_72_18
[18] Sarac IS, Aksu Y, Yildiz D, Yilmaz A. Rhino-Orbital Mucormycosis Presenting With Central Retinal Artery
Occlusion: A Case Report. Cureus. 2025;17(7):e88020. https://doi.org/10.7759/cureus.88020
[19] Tandon M, Sheemar A, Bhatnagar K, Meena S, Shakrawal J. Central Retinal Artery Occlusion in Rhino-Orbital-Cerebral Mucormycosis: An Inflammatory-Prothrombotic State. Asia Pac J Ophthalmol (Phila). 2023;12(1):16-20. https://doi.org/10.1097/APO.0000000000000593
[20] Sumual V, Lukandy A, Sutanto RL. Secondary central retinal artery occlusion due to rhino-orbital-cerebral
mucormycosis in a diabetic patient: a case report. Ann Med Surg (Lond). 2024;86(1):507-11. https://doi.org/10.1097/
MS9.0000000000001504
[21] Gelston CD, Durairaj VD, Simoes EAF. Rhino-orbital Mucormycosis Causing Cavernous Sinus and Internal
Carotid Thrombosis Treated With Posaconazole. Arch Ophthalmol. 2007;125(6):848-9. https://doi.org/10.1001/
archopht.125.6.848
[22] Kamath GM, Jeganathan S, Salim S, Antony RM, Kamath AR, Hiran H. Case series of central retinal artery occlusion in COVID-19-associated rhino-orbital-cerebral mucormycosis. Indian J Ophthalmol. 2023;71(7):2904-6. https://doi.org/10.4103/IJO. IJO_3123_22
[23] Tandon M, Sheemar A, Bhatnagar K, Meena S, Shakrawal J. Central Retinal Artery Occlusion in Rhino-Orbital-Cerebral Mucormycosis: An Inflammatory-Prothrombotic State. Asia Pac J Ophthalmol (Phila). 2023;12(1):16-20. https://doi.org/10.1097/APO.0000000000000593
[24] Bawankar P, Lahane ST, Pathak PR, Gonde PP, Singh AH. Central retinal artery occlusion as the presenting manifestation of invasive rhino-orbital-cerebral mucormycosis. Taiwan JOphthalmol. 2020;10:62-5. https://doi.org/10.4103/tjo.tjo_72_18
[25] Kim JP, Park BJ, Lee MS, Lim YJ. Occlusion of the Internal Carotid Artery due to Intracranial Fungal Infection. J Korean Neurosurg Soc. 2011;49(3):186-9. https://doi.org/10.3340/jkns.2011.49.3.186
[26] Chang BYP, Davey KG, Gupta M, Hutchinson C. Late clouding of an acrylic intraocular lens following routine
phacoemulsification. Eye. 1999;13(6):807-8. https://doi.org/10.1038/eye.1999.241
[27] Jeon SW, Kim CH, Kim JY, Kwon JH. A Case Of Cavernous Sinus Syndrome and Mutifocal Cerebral Infarction Related To Mucormycosis Of Sphenoid Sinus. Korean Med J. 2018;33(3):454-62. https://doi.org/10.7180/kmj.2018.33.3.454
[2] Ribes JA, Vanover-Sams CL, Baker DJ. Zygomycetes in human disease. Clin Microbiol Rev. 2000;13(2):236-301. https://doi.org/10.1128/CMR.13.2.236
[3] Gale GR, Welch AM. Studies of opportunistic fungi. I. Inhibition of Rhizopus oryzae by human serum. 1961. https://
doi.org/10.1097/00000441-196105000-00008
[4] Ferguson BJ. Mucormycosis of the nose and paranasal sinuses. Otolaryngol Clin North Am. 2000;33(2):349-65. https://doi.org/10.1016/S0030-6665(00)80010-9
[5] Greenberg RN, Scott LJ, Vaughn HH, Ribes JA. Zygomycosis (mucormycosis): emerging clinical importance and new
treatments. Curr Opin Infect Dis. 2004;17(6):517-25. https://doi.org/10.1097/00001432-200412000-00003
[6] Roden MM, Zaoutis TE, Buchanan WL, Knudsen TA, Sarkisova TA, Schaufele RL, et al. Epidemiology and outcome of
zygomycosis: a review of 929 reported cases. Clin Infect Dis. 2005;41(5):634-53. https://doi.org/10.1086/432579
[7] Jeong W, Keighley C, Wolfe R, Lee WL, Slavin M, Kong D, et al. The epidemiology and clinical manifestations of
mucormycosis: a systematic review and meta-analysis of case reports. Clin Microbiol Infect. 2019;25(1):26-34. https://doi.org/10.1016/j.cmi.2018.07.011
[8] Harrill WC, Stewart MG, Lee AG, Cernoch P. Chronic rhinocerebral mucormycosis. Laryngoscope. 1996;106
(10):1292-7. https://doi.org/10.1097/00005537-199610000-00024
[9] Pakdel F, Mardani M, Salehi M, Khodavaisy S, Tabari A. Practice guideline on prevention, diagnosis, and treatment
of rhino-orbito-cerebral mucormycosis in the COVID-19 area: a consensus of Iranian experts. Arch Clin Infect Dis.
2022;17:e127072. https://doi.org/10.5812/archcid-127072
[10] Dong N, Jordan AE, Shen X, Wu X, Guo X, Zhao H, et al. Rhino-Orbital Cerebral Mucormycosis in a Patient With
Diabetic Ketoacidosis: A Case Report and Literature Review. Front Neurol. 2022;13:815902. https://doi.org/10.3389/
fneur.2022.815902
[11] Sreshta K, Dave TV, Varma DR, Nair AG, Bothra N, Naik MN, et al. Magnetic resonance imaging in rhino-orbital-cerebral mucormycosis. Indian J Ophthalmol. 2021;69(7):1915-27. https://doi.org/10.4103/ijo.IJO_1439_21
[12] Manjunath KS, Shivaswamy S, Kulkarni JD, Kenkare Venkatachalaiah R. Rhino-orbito-cerebral mucormycosis
(ROCM) with internal carotid artery stenosis in a diabetic patient with caries tooth and oroantral fistula. BJR Case Rep.
2016;2(2):20150447. https://doi.org/10.1259/bjrcr.20150447
[13] Agrawal A, Tripathi PS, Shukla P, Nigam P, Kheti P. Intracranial manifestations of rhinocerebral mucormycosis: a pictorial essay. Egypt J Radiol Nucl Med. 2022;53(1):86. https://doi.org/10.1186/s43055-022-00765-5
[14] Safder S, Carpenter JS, Roberts TD, Bailey N. The “Black Turbinate” Sign: An Early MR Imaging Finding of Nasal
Mucormycosis. AJNR Am J Neuroradiol. 2010;31(4):771. https://doi.org/10.3174/ajnr.A1808
[15] Chandran V, Swee Ying C, Hosnaliza SI, Nasaruddin RA, Che Hamzah J. Rhino-Orbital Mucormycosis Presenting As Orbital Apex Syndrome With Central Retinal Artery Occlusion: A Rare Phenomenon. Cureus. 2024;16(11):e73400. https://doi.org/10.7759/cureus.73400
[16] Patil A, Mohanty HS, Kumar S, Nandikoor S, Meganathan P. Angioinvasive rhinocerebral mucormycosis with complete unilateral thrombosis of internal carotid artery-case report and review of literature. BJR Case Rep. 2016;2(2). https://doi.org/10.1259/bjrcr.20150448
[17] Bawankar P, Lahane S, Pathak P, Gonde P, Singh A. Central retinal artery occlusion as the presenting manifestation
of invasive rhino-orbital-cerebral mucormycosis. Taiwan J Ophthalmol. 2020;10(1):62-5. https://doi.org/10.4103/tjo.
tjo_72_18
[18] Sarac IS, Aksu Y, Yildiz D, Yilmaz A. Rhino-Orbital Mucormycosis Presenting With Central Retinal Artery
Occlusion: A Case Report. Cureus. 2025;17(7):e88020. https://doi.org/10.7759/cureus.88020
[19] Tandon M, Sheemar A, Bhatnagar K, Meena S, Shakrawal J. Central Retinal Artery Occlusion in Rhino-Orbital-Cerebral Mucormycosis: An Inflammatory-Prothrombotic State. Asia Pac J Ophthalmol (Phila). 2023;12(1):16-20. https://doi.org/10.1097/APO.0000000000000593
[20] Sumual V, Lukandy A, Sutanto RL. Secondary central retinal artery occlusion due to rhino-orbital-cerebral
mucormycosis in a diabetic patient: a case report. Ann Med Surg (Lond). 2024;86(1):507-11. https://doi.org/10.1097/
MS9.0000000000001504
[21] Gelston CD, Durairaj VD, Simoes EAF. Rhino-orbital Mucormycosis Causing Cavernous Sinus and Internal
Carotid Thrombosis Treated With Posaconazole. Arch Ophthalmol. 2007;125(6):848-9. https://doi.org/10.1001/
archopht.125.6.848
[22] Kamath GM, Jeganathan S, Salim S, Antony RM, Kamath AR, Hiran H. Case series of central retinal artery occlusion in COVID-19-associated rhino-orbital-cerebral mucormycosis. Indian J Ophthalmol. 2023;71(7):2904-6. https://doi.org/10.4103/IJO. IJO_3123_22
[23] Tandon M, Sheemar A, Bhatnagar K, Meena S, Shakrawal J. Central Retinal Artery Occlusion in Rhino-Orbital-Cerebral Mucormycosis: An Inflammatory-Prothrombotic State. Asia Pac J Ophthalmol (Phila). 2023;12(1):16-20. https://doi.org/10.1097/APO.0000000000000593
[24] Bawankar P, Lahane ST, Pathak PR, Gonde PP, Singh AH. Central retinal artery occlusion as the presenting manifestation of invasive rhino-orbital-cerebral mucormycosis. Taiwan JOphthalmol. 2020;10:62-5. https://doi.org/10.4103/tjo.tjo_72_18
[25] Kim JP, Park BJ, Lee MS, Lim YJ. Occlusion of the Internal Carotid Artery due to Intracranial Fungal Infection. J Korean Neurosurg Soc. 2011;49(3):186-9. https://doi.org/10.3340/jkns.2011.49.3.186
[26] Chang BYP, Davey KG, Gupta M, Hutchinson C. Late clouding of an acrylic intraocular lens following routine
phacoemulsification. Eye. 1999;13(6):807-8. https://doi.org/10.1038/eye.1999.241
[27] Jeon SW, Kim CH, Kim JY, Kwon JH. A Case Of Cavernous Sinus Syndrome and Mutifocal Cerebral Infarction Related To Mucormycosis Of Sphenoid Sinus. Korean Med J. 2018;33(3):454-62. https://doi.org/10.7180/kmj.2018.33.3.454
| Files | ||
| Issue | Vol 10 No 4 (2025): July-August | |
| Section | Case Report(s) | |
| DOI | https://doi.org/10.18502/crcp.v10i4.21106 | |
| Keywords | ||
| Mucormycosis Retinal artery Orbit Diabetes mellitus Fungal infection | ||
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How to Cite
1.
Rajabi A, Forouzandeh H, Torfeh Esfandi AA, Khorasanizadeh G. Unusual Case of Mucormycosis-Associated Central Retinal Artery Occlusion without Orbital Involvement: A Case Report. CRCP. 2026;10(4):147-153.
