Abstract Introduction Mucormycosis is an aggressive, angioinvasive fungal infection that predominantly affects individuals with impaired immunity. The infection usually involves the paranasal sinuses, central nervous system, or lungs; sudden vision loss from central retinal artery occlusion (CRAO) is rare and clinically distinctive. Although uncontrolled diabetes, high-dose corticosteroids, and hematologic malignancy are the most recognized risk factors, mucormycosis without diabetes is rare, particularly in patients with cirrhosis-related immune dysfunction. We describe an autopsy-confirmed case of disseminated mucormycosis initially misattributed to giant cell arteritis (GCA) in a non-diabetic patient with decompensated cirrhosis. Case Report A 57-year-old man with alcohol-related cirrhosis (Child-Pugh Class C), hepatic encephalopathy, congestive heart failure, and gout presented with sudden, painless left-sided vision loss after three days of headache. Eye exam showed retinal whitening with a cherry-red spot and visible emboli, consistent with CRAO. Laboratory studies showed thrombocytopenia and hyperbilirubinemia (total bilirubin 6.3 mg/dL). MRI revealed no acute stroke, and CT angiography demonstrated atherosclerosis without major vessel obstruction. Because he also had jaw pain and scalp tenderness, GCA was suspected, and high-dose prednisone (60 mg daily) was started on admission. Within 48 hours, he developed bilateral vision loss, encephalopathy, and respiratory failure. Labs showed progressive leukocytosis (WBC 24 × 109/L), acute kidney injury (Cr 2.1 mg/dL), and severe transaminitis (AST 209 U/L). Chest imaging revealed new left-lower-lobe consolidation. Despite broad-spectrum antibiotics and supportive care, he became hypotensive and unresponsive. Given worsening hepatic encephalopathy and sepsis, further diagnostics were deferred. After a family goals-of-care discussion, treatment was transitioned to comfort measures, and he died on hospital day 7. Autopsy revealed extensive angioinvasive mucormycosis involving the sinuses, orbit, retina, and lungs, with vascular thrombosis correlating with bilateral CRAO and respiratory failure. Histopathology showed broad, non-septate hyphae, branching at right angles, confirming Mucorales species. Discussion This case underscores the diagnostic challenge of mucormycosis mimicking GCA in a patient without classic metabolic risk factors. Mucormycosis remains rare, with an estimated global incidence of 0.005-1.7 cases per million and mortality of 31-95% depending on disease site. Only a few dozen cases have been reported in patients with cirrhosis, and this appears to be the first presenting as GCA mimicry in a non-diabetic patient. Rapid progression following corticosteroid initiation highlights the risk of disseminated fungal infection in cirrhosis-associated immune dysfunction. New vision loss and systemic deterioration in such patients should prompt early evaluation for invasive fungal disease to allow timely antifungal therapy. This abstract is funded by: None
Harikrishnan et al. (Fri,) studied this question.