A 71-year-old Hispanic gentleman with poorly controlled diabetes, hypertension, hyperlipidemia, and chronic sinusitis, initially presented with acute onset horizontal binocular diplopia. Examination revealed right sixth and partial third nerve palsies. MRI did not reveal acute stroke. Additional workup of toxic, autoimmune, and infectious etiologies was unrevealing and he was discharged with a diagnosis of diabetic cranial neuropathy with recommendations to optimize neurovascular risk factors.
He re-presented four weeks later with progressive dysphagia, dysarthria, right otalgia and hearing loss. ENT noted a peri-pharyngeal mass, followed by CT revealing subtle effacement of bilateral pharyngeal recesses with heterogenous mucosal enhancement, and bilateral mastoid and middle ear effusions. He was initiated on broad spectrum antibiotics for mastoiditis. MRI brain/orbits showed enhancement of the right orbital apex with suspected involvement of the superior and inferior orbital fissures. CT of the temporal bone confirmed right mastoiditis with concomitant osteomyelitis and a focal bony defect in the roof of the middle cranial fossa. Ear cultures and mastoid biopsy revealed C.parapsilosis. In addition to antifungal treatment, patient also required extensive supportive care but passed away several weeks later. <br bcx0"="">