A cranial nerve palsy may cause a complete or partial weakness or paralysis of the areas served by the affected nerve. In the case of a cranial nerve that has multiple functions (such as the oculomotor nerve), a palsy can affect all of the various functions or only some of the functions of that nerve. Usually, the third, fourth, and sixth cranial nerves participate in eyeball movement by extraocular muscle control. Acquired palsy of these nerves can result from various causes such as trauma, vascular disease, intracranial tumors, or aneurysm, and so on.

The largest report from the Mayo Clinic, which included 4278 patients over 30 years, identified sixth nerve palsy and undetermined cause as having the highest prevalence. In advanced disease chemosis, ptosis, proptosis, ophthalmoplegia and blindness and multiple cranial nerve function may be lost or impaired [1]. A meticulous history, detailed workup, confirmation of diagnosis by histopathology and culture helps to make a diagnosis. Aggressive management of these patients can reverse the adverse outcome. Prognosis is directly related to the length of time before diagnosis and treatment [2].

In parallel, mucormycosis, a rare opportunistic invasive fungal infection, is known to be fatal and aggressive. Mucormycosis is a term used to refer to any fungal infections of the order Mucorales, which belongs to class Zygomycetes. Rhinocerebreal mucormycosis is a rare but fatal infection of the nasal cavity and sinuses. The incidence of mucormycosis is approximately 1.7 cases per 1,000,000 inhabitants per year [3]. Mucormycosis rarely affects otherwise healthy people. It is a disease of patients with a pre-existing debilitating disease (diabetes mellitus) or is receiving immunosuppressive therapy. It is characterized by an aggressive necrotizing infection spreading from the nose to the paranasal sinuses, orbit, and brain. This disease is most often associated with diabetics but can be seen with Chronic Kidney disease, leukemia, malnutrition, AIDS, steroid, antimetabolic or antibiotic therapy, severe burn, septicemia, and treatment with immunosuppressive medications. Early clinical recognition of this potentially fatal disease is essential before irreversible changes occur [4,5].

We describe the case of a 60-year-old female patient who suffered complications of rhinocerebral mucormycosis while she was hospitalized.

Figure-1: Histopathology smear showing broad non septate hyphae of Mucor

Figure 2 -A-before initiation of amphotericin B - after initiation of amphotericin

The fungal infection in a diabetic and immunosuppressed individual leads to fatal nasal Sinusitis, orbit and skull invasion of the patients. The incidence of this uncommon disease is uncertain; only 500 instances were found during a study of the literature between 1970 and 2020 [6]. The sickness was regarded as generally deadly and untreatable almost the following decade after Gregory et al. initially described it in US literature in the year 1943. Fungi from the Mucorales family Mucoraceae, most frequently from the Rhizopus, Mucor and Absidian genera are /responsible for Mucormycosis [7]. Cultivated by oral and nasal mucosa of humans without disease, Mucorales spores are all-round in nature and frequently present in bread, soil and fruit. Various kinds of human mucosal infection are recognized: pulmonary, cutaneous, gastrointestinal, central nervous system (CNS) [8]. The RCM is of particular importance for emergency doctors since it may be misdiagnosed with sinusitis, ocular cellulitis, cavernous sinus thrombosis and viral illness. Its survival rate is also linked, as explained below, to early diagnosis [9]. Moreover, mild anaemia is usually seen with aneutrophilic leucocytosis. Fungal Hyphae, aseptate, 90-degree branching, irregularly large and necrosis and haemorrhaging zones, are shown in the microscopic exam. Necrosis, polymorphonuclear infiltration, multinucleated giant cells and aseptate hyphae are present. Patients frequently experience facial and orbital discomfort, loss of vision and widespread swelling on the afflicted side. In individuals with mucormycosis multiple cranial nerve paralysis is also recorded. [10]. The CT of the sinuses showing oedema, the filling fluid in the ethmoid sinuses and periorbital tissue damage and borders are part of diagnostic imaging. Standard medical treatment based on clinical response and degree of nephrotoxicity is amphotericin B at 1-5mg/kg/day for 4 weeks.