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Case Report
Unilateral optic neuritis with contralateral central retinal artery and central retinal vein occlusion in a post-COVID-19 case of rhino-orbital-cerebral mucormycosis: An unusual presentation
1 Ophthalmology, Consultant Vitreo-Retina and Uvea, Department of Retina-Vitreous and Uvea, Amritsar Eye Clinic, Dehradun, Uttarakhand, India
2 Radiodiagnosis, Assistant Professor, Department of Radiodiagnosis and Imaging, Teerthanker Mahaveer Medical College and Research Centre Meerut, Uttar Pradesh, India
3 Radiodiagnosis, Consultant Radiodiagnosis, Department of Radio diagnosis and Imaging, Dr. Parashars Pathology and Imaging Centre, Dehradun, Uttarakhand, India
4 Medicine, Associate Professor, Department of Medicine, Shri Guru Ram Rai Institute of Medical and Health Sciences and Shri Mahant Inderesh Hospital, Dehradun, Uttarakhand, India
5 Ophthalmology, Consultant and Chief Cataract and Refractive Surgeon, Department of Cataract and Refractive Surgery, Amritsar Eye Clinic, Dehradun, Uttarakhand, India
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Deepesh Arora
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Article ID: 101312Z01DA2022
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How to cite this article
Arora D, Sharma A, Raman R, Parasher A, Ahamad N, Sharma D. Unilateral optic neuritis with contralateral central retinal artery and central retinal vein occlusion in a post-COVID-19 case of rhino-orbital-cerebral mucormycosis: An unusual presentation. Int J Case Rep Images 2022;13(1):6–14.ABSTRACT
Introduction: The corona virus disease (COVID)-19 is a severe acute respiratory syndrome (SARS-CoV-2) which is posing a great threat to mankind and has been associated with a high risk of opportunistic fungi infection presenting as rhino-orbital-cerebral-mucormycosis. We report a rare and never reported case of unilateral optic neuritis with contralateral central retinal artery (CRA) and central retinal vein (CRV) occlusion in a patient of post-COVID-19 rhino-orbital-cerebral-mucormycosis.
Case Report: A 45-year-old diabetic, Indian gentleman reported to our clinic in Dehradun, Uttarakhand, India with complaints of bilateral diminution of vision in right eye (RE) five days and left eye (LE) five weeks duration. He provided recent history of COVID-19 infection for which he was hospitalized and treated. Fundus examination confirmed optic neuritis in right eye and a combined established central retinal artery and vein occlusion in left eye. Fundus fluorescein angiography, visual evoked potential, and magnetic resonance imaging (MRI) were crucial in clinching the diagnosis.
Conclusion: Rhino-orbital-cerebral-mucormycosis invades tissue through multiple routes. However, it is extremely rare to see a combination of angioinvasion leading to visual loss in one eye and perineural spread leading to optic neuritis and visual loss in the contralateral eye. Clinicians must be aware of such rare presentations which could serve as benchmark in diagnosis and treatment.
Keywords: Angioinvasion, Mucormycosis, Optic neuritis, Perineural invasion
SUPPORTING INFORMATION
Author Contributions
Deepesh Arora - Conception of the work, Design of the work, Acquisition of data, Drafting the work, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Anuj Sharma - Drafting the work, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Ratish Raman - Analysis of data, Drafting the work, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Ankit Parasher - Acquisition of data, Drafting the work, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Niyaaz Ahamad - Drafting the work, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Dinesh Sharma - Drafting the work, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Guarantor of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2022 Deepesh Arora et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
