[9] A necrotic eschar in maxillary, facial, or sino-orbital mucosal surfaces in an immunocompromised host may be an early this website sentinel marker of invasive

mucormycosis. Pleuritic pain in a neutropenic host also may signify an angioinvasive filamentous fungus. Pleuritic pain in a neutropenic or HSCT patient receiving voriconazole prophylaxis has a high probability of being invasive mucormycosis instead of aspergillosis. Diplopia is an early manifestation of sino-orbital mucormycosis in a diabetic patient that usually signifies involvement of the extraocular muscles or their innervating nerves.[10] Hyperglycaemia in diabetic patients may produce blurring of vision, but does not produce diplopia. During sino-orbital mucormycosis, hyphae involving the ethmoid sinus breach the lamina papyracea to invade the medial rectus muscle creating dysconjugate vision. The organism may extend along the emissary veins to the ethmoid sinus to the cavernous sinus and encroach upon the critical cranial nerves involve III, IV, V (1, 2) and VI. Diplopia in a diabetic patient or other compromised host with ethmoidal sinusitis should be assessed aggressively for sino-orbital mucormycosis. Necrotic cutaneous lesions in immunocompromised

patients may also be caused by mucormycosis. The differential diagnosis includes Enzalutamide clinical trial other angioinvasive pathogens including Aspergillus, Fusarium, Pseudallescheria, Scedosporium species. Pseudomonas aeruginosa and occasionally members of Enterobacteriaceae in the same host also cause ecthyma gangrenosum. The preponderance

of cases of cutaneous mucormycosis is associated with direct inoculation rather than haematogenous dissemination.[1] Characteristic hyphal structures are seen on biopsy MTMR9 and wet mount of tissue. Earlier recognition of sinus and pulmonary lesions by CT scanning is an important advance over conventional sinus and chest radiographs. Early CT findings may reveal pulmonary or sinus lesions before localising symptoms in immunocompromised patients who are at high risk for invasive sino-pulmonary mucormycosis. Among the lesions associated with angioinvasive filamentous fungi are nodules, halo signs, reverse halo signs, cavities, wedge-shaped infiltrates and pleural effusions associated with pleuritic pain.[11] Among these lesions, the reverse halo sign in the neutropenic patient has high predictive value for mucormycosis.[12] Early recognition of risk factors, clinical manifestations and diagnostic imaging findings may increase the probability of an early recognition and lead logically to a definitive diagnosis by culture and biopsy of tissue or the use of novel molecular and antigenic assays.