Rapid Vision Loss After Root Canal Treatment Due to Invasive Fungal Sinusitis

Ear Nose Throat J. 2024 Sep;103(2_suppl):7S-11S. doi: 10.1177/01455613241281861. Epub 2024 Sep 20.

Abstract

We present a novel case of acute invasive fungal rhinosinusitis (AIFRS) following a maxillary molar root canal in a 69-year-old diabetic female, who subsequently developed unilateral vision loss. The patient reported a 1-week history of progressive left facial pain, trismus, and numbness following the procedure. Initial evaluation was unremarkable, but her condition rapidly deteriorated, culminating in complete vision loss in the left eye. Imaging studies revealed opacification of the left-sided sinuses and a rim-enhancing collection in the left pterygopalatine fossa. Surgical debridement confirmed mucormycosis. The therapeutic approach included systemic and retrobulbar amphotericin B administration, along with multiple sinonasal debridements. The patient's poorly controlled diabetes mellitus significantly contributed to the rapid progression of the infection. Retrobulbar amphotericin B injections were effective in managing orbital involvement, thus avoiding the need for exenteration. Early diagnosis and aggressive treatment are paramount in improving outcomes for patients with AIFRS.

Keywords: amphotericin B; invasive fungal sinusitis; mucormycosis; vision loss.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Amphotericin B / administration & dosage
  • Amphotericin B / therapeutic use
  • Antifungal Agents / administration & dosage
  • Antifungal Agents / therapeutic use
  • Blindness / etiology
  • Debridement / methods
  • Female
  • Humans
  • Invasive Fungal Infections / drug therapy
  • Mucormycosis* / complications
  • Rhinitis / complications
  • Rhinitis / microbiology
  • Root Canal Therapy* / adverse effects
  • Root Canal Therapy* / methods
  • Sinusitis* / complications
  • Sinusitis* / microbiology

Substances

  • Antifungal Agents
  • Amphotericin B