Answer 19

 

There are many views about this case, some of which were logic and others were unlogic.

 

From the logic views:

- Cavernous sinus thrombosis:

While this diagnosis is initially acceptable since it can explain the ophthalmoplegia, there are some objections since it could not explain the following:

    - the normal vasculature of the fundus

    - facial nerve affection

    - absence of trigeminal neuropathy (ophthalmic and maxillary)

However radiological studies proved free cavernous sinus.

 

- Mucormycosis:

It is wise to consider aggressive type of infection in our patient because she is diabetic and we consider mucormycosis an emergency situation in diabetics but absence of significant local inflammation characterizing the mucormycosis and tendency for attacking cranial nerves only make this diagnosis unlikely.

 

Now if we collected the physical findings there are 2, 3 , 4, 6 and 7th cranial nerves affection in addition to facial and ocular inflammation i.e. there are multiple related and unrelated cranial nerves palsies (polyneuritis cranialis).

 

What is the etiology?

If we considered the last months of inexplicable fever and running nose that was refractory to the usual lines of treatment, it is a case of small vessel vasculitis: [Unclassic Wegener's Granulomatosis].