The “black evil” affecting patients with diabetes: a case of rhino orbito cerebral mucormycosis causing Garcin syndrome

Figures & data

Figure 1 Drooping of right eyelid, drooling of saliva, and facial deviation to left side.

Figure 2 Chemosis, proptosis and ophthalmoplegia of right eye.

Figure 3 Deviation of tongue to the right (right hypoglossal nerve palsy).

Figure 4 Black eschar with erosion of the hard palate on the right side.

Table 1 Hematological and biochemical investigations

Investigation	Results	Reference range
Hemoglobin	10.6 g/dL	12–16 g/dL
Total leukocyte count	16,000 cells/mm^3	4,000–11,000 cells/mm^3
Differential count
Polymorphs	76%	40%–70%
Lymphocytes	20%	20%–45%
Eosinophils	2%	1%–6%
Basophils	1%	0%–2%
Monocytes	1%	2%–10%
ESR	76 mm in 1st hour	0–20 mm in 1st hour
Glucose, random	536 mg/dL	80–120 mg/dL
Arterial blood gas analysis
pH	7.2	7.35–7.45
PO2	99 mmHg	80–100 mmHg
PCO2	32 mmHg	35–45 mmHg
HCO3	12 mEq/L	22–26 mEq/L
Urine ketone bodies	Positive

Abbreviation: ESR, erythrocyte sedimentation rate.

Figure 5 Computed tomography of paranasal sinuses showing right maxillary sinusitis with spread of inflammation to infratemporal fossa.

Figure 6 Rhizopus growth in Sabouraud’s dextrose agar.

Figure 7 Filamentous branching aseptate hyphae with sporangia.

Note: Magnification: 40×.

Figure 8 Angioinvasion by fungal hyphae (arrow).