Meningo-encephalo-vasculitis, optic neuritis, and thrombotic complications: About a fulminant mucormycosis in a diabetic patient (original) (raw)
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Case Report of Rhino-Orbital Mucormycosis in a Diabetic, with Excellent Outcome
British Journal of Medicine and Medical Research, 2015
Acute sinusitis secondary to virulent organisms can initially be subtle, or might be misdiagnosed as viral sinusitis. It is one of the most common diagnoses we face in clinical practice. Among all the variable etiologies, fungal sinusitis is the most obscure with devastating consequences. The purpose of this case report is to increase the awareness of health care professionals about invasive fungal sinusitis as an under-diagnosed disease, and emphasize that excellent outcome can be achieved by early employment of different therapeutic modalities. In this case report, we review an older adult male, with significant cardiac and diabetes history, who presented with acute rhino-orbital mucormycosis, and was successfully treated with prompt endoscopic surgical debridement, dual IV antifungals, local amphotericin B nasal washing, and hyperbaric oxygen therapy. All of the above led to extremely favorable outcome for such an aggressive infection.
International Journal of Research in Medical Sciences, 2024
Rhino-orbito-cerebral mucormycosis (ROCM) is a severe and often fatal fungal infection that primarily affects immunocompromised individuals, especially those with diabetes mellitus. The fungi, primarily Rhizopus oryzae, exhibit angio-invasive properties leading to extensive tissue necrosis and vascular occlusion, contributing to high morbidity and mortality. Early diagnosis and prompt intervention are crucial for improving patient outcomes. We present the case of a 32-year-old female with uncontrolled type 1 diabetes mellitus who experienced progressive blackening of the skin on the right side of her face, weakness in both upper and lower limbs, swelling in the right orbital region, proptosis, and diminished vision in her right eye over 10 days. Diagnosis was made through physical examination and MRI findings. The patient underwent extensive debridement surgery and was treated with intravenous amphotericin B. MRI indicated complete mucosal thickening and air-fluid levels in the right maxillary sinus extending to the ethmoid, frontal, and sphenoid sinuses, and the "Black turbinate sign" was observed in the ipsilateral turbinates. Additional findings included right orbital cellulitis with endophthalmitis, optic neuritis, and an acute infarct in the right temporal lobe and ipsilateral lentiform nucleus. Successful surgical debridement and antifungal therapy followed the ROCM diagnosis. This case highlights the need for a high index of suspicion for ROCM in diabetic patients with facial and orbital symptoms, and emphasizes the necessity of early imaging and aggressive treatment to reduce the associated high risks.
Presentation and outcome of rhino-orbital-cerebral mucormycosis in patients with diabetes
Postgraduate Medical Journal, 2004
Aim: To report presentation and outcome of rhino-orbital-cerebral mucormycosis (ROCM) exclusively in patients with diabetes mellitus. Methods: Retrospective, non-comparative, interventional analysis of the medical records of 35 patients with ROCM among 22 316 patients with diabetes seen over the last 12 years. Results: A cohort of 23 men and 12 women with a mean (SD) age of 47.3 (14.4) years (range 18–70 years) was studied. Five patients had type 1 diabetes mellitus, 29 had type 2 diabetes mellitus, and one had secondary diabetes. Nine patients had ROCM as the first clinical manifestation of diabetes. The mean (SD) blood glucose at presentation was 20.6 (8.3) mmol/l (range 10.0 to 53.3 mmol/l) and 17 patients had ketosis/ketoacidosis. Ophthalmic symptoms and signs were pronounced: external ophthalmoplegia (89%), proptosis (83%), visual loss (80%), chemosis (74%), and eye lid gangrene (14%). Non-ophthalmic manifestations included sinusitis (100%), nasal discharge/ulceration (74%), in...
Invasive rhinocerebral mucormycosis with orbital extension in poorly- controlled diabetes mellitus
Singapore medical journal, 2009
Rhinocerebral mucormycosis is an invasive fungal sinusitis with a high mortality rate, especially in immunocompromised patients. A 70-year-old woman, with uncontrolled type 2 diabetes mellitus, presented with a one-month history of non-specific headaches associated with progressive swelling of her left eye. Computed tomography of the brain and orbits showed the extensive involvement of bilateral intranasal sinuses, orbits, extraocular muscle and soft tissues. The diagnosis of invasive mucormycosis was confirmed from a tissue biopsy taken from the internasal septum. Despite the extensive mucormycosis invasion, she was successfully treated with intranasal and systemic amphotericin B and minimal adjunctive intranasal sphenoidotomy.
BIRDEM Medical Journal, 2012
Mucormycosis is a form of fulminant invasive fungal infection of the sinonasal tract that often extends to the orbit, brain, palate, and skin. It is caused by members of the order Mucorales, and it is considered to be the most fatal fungal infection known to man. It is most commonly associated with diabetic ketoacidosis, hematologic malignancies, acquired immunodeficiency syndrome acquired immunodeficiency syndrome, see AIDS. , and immunosuppressive therapy. This rare opportunistic infection exists in many forms, the most common of which is rhinocerebral mucormycosis. Treatment includes aggressive surgical debridement of the necrotic tissue combined with systemic antifungal therapy. In this case report, we describe the successful management of rhinoorbitocerebral mucormycosis, a subtype of the rhinocerebral variety, complicated by osteomyelitis of cranium. We review the diagnostic work-up and discuss the literature with respect to the presentation, pathophysiology, management, and o...
Case Report FUNGAL PANSINUSITIS LEADING TO ORBITAL COMPLICATIONS IN POORLY CONTROLLED DIABETES
2015
Mucormycosis is a rare infection caused by fungus belonging to the order mucorales. They are known opportunistic organisms, which potentially invade and infect a host with compromised immunity. Mucormycosis can present in different clinical forms. The common clinical types include rhinocerebral, pulmonary, gastrointestinal, disseminated and miscellaneous forms. Rhinocerebral mucormycosis is the most characteristic form and frequently involves the structures of the head and neck. It usually occurs in diabetic patients, especially when the diabetes is poorly controlled. The infection usually begins in the paranasal sinus or palate and then invades the adjacent sinuses and retroorbital region. It may extend through the apex of the orbit into the brain. This progression of the lesion gives a characteristic picture, with headache, swelling of the face, intranasal necrosis and serosanguinous discharge, marked proptosis, ptosis and ophthalmoplegia and loss of vision. All these are typicall...
Rhino-orbital-cerebral mucormycosis in type 1 diabetes mellitus
Indian Journal of Pediatrics, 2005
AIM : To describe the presentation and outcome of rhino-orbital-cerebral mucormycosis (ROCM) in adolescents with type 1 diabetes mellitus (T1 DM).Methods : the medical records of six patients of T1 DM with ROCM admitted between October 2001 to January 2004 were analysed.Results : the mean (± SD) age and duration of DM of these patients were 16.1 ±3.0 years and 26.3 ± 24.9 months respectively. Four patients had ROCM at presentation, while two developed it during their hospital stay when recovering from diabetic ketoacidosis. Proptosis (100%) and ptosis (100%) were the most common symptoms, and ophthalmoplegia (85%) and vision loss (85%) were the most common signs. Maxillary sinus (85%) was the commonest paranasal sinus to be involved. All patients received amphotericin B and had appropriate surgery except one. Four patients survived. Patients who had altered sensorium, facial necrosis, palatal perforation and cerebral involvement at presentation had poor outcome.Conclusion : High index of suspicion of ROCM in T1 DM and combined approach with amphotericin B and appropriate surgery is rewarding.
Rhino- Orbito Cerebral Mucormycosis – Uncontrolled, Untimely and Unsaved
Saudi Journal of Medicine, 2019
Mucormycosis is an opportunistic fungal infection primarily caused by fungi belongs to class Zygomycetes, order Mucorales and family Mucoracae. It is common in patient with diabetes mellitus (DM), systemic immunocompromise and iron overload. Here by we present a case report of Rhino-Orbito Cerebral Mucormycosis which is fatal if undiagnosed and unterated in correct time and way.