Mucormycosis in a surgical defect masquerading as osteomyelitis: a case report and review of literature

Abstract

Mucormycosis is a rare, highly lethal opportunistic fungal disease affecting immune compromised and diabetic patients. Mucormycosis is considered as the 3rd most common invasive mycosis after candidiasis and aspergillosis in debilitating patients. It is caused by the filamentous fungi of the class zygomycetes. The infection usually begins in the nose due to inhalation of fungal spores. This fatal fungal disease needs a prompt and early definitive diagnosis, aggressive surgical therapy and high dose anti-fungal therapy. Here, we present a case report of Mucormycosis in a 64 year elderly diabetic male patient who was previously operated for myiasis and also the extensive review of the literature of the mucormycosis.

Rhinomaxillary mucormycosis presenting as palatal ulcer: A case report with comprehensive pathophysiology

“…McDonogh hypotheticated that any diabetic patient with ketoacidosis showing clinical and radiographic features of sinusitis should be suspected as a case of mucormycosis until proven otherwise. [ 7 ] In our case, there was no evidence of bony erosion or involvement of sinuses on contrast CT scan, fungus manifested as a localized lesion of the maxilla, this is similar to some previously documented reports. [ 10 ]…”

“…Another virulence factor of fungus is its ability to thrive on unbound iron found in host serum due to deranged binding of serum transferrin with iron under the acidic environment of diabetes. [ 6 7 ] The port of entry for organism is usually nasal mucosa, from where it can invade into paranasal sinuses through angioinvasion. Pterygopalatine fossa acts as a reservoir for fungus from where it can spread into retro-orbital or infratemporal space.…”

“…Supportive measures such as hyperbaric oxygen may play a beneficial role by neovascularization of viable tissue and reducing lactic acidosis. [ 7 ]…”

Palatal mucormycosis masquerading as bacterial and fungal osteomyelitis: A rare case report

“…Successful treatment of mucormycosis consists of aggressive and repeated surgical debridement of necrotic tissue, systemic antifungal therapy, and immediate control of the underlying systemic diseases. [ 12 ] Use of amphotericin B, an antifungal agent, is widely advocated in literature for treatment of this lesion, but it should be used with caution due to the risk of development of an amphotericin-induced nephrotoxicity. In case of palatal perforation, rehabilitation of the patient can be achieved surgically using free flaps or by constructing an obturator.…”

Literature Review: HYPERBARIC OXYGEN THERAPY ON MUCORMYCOSIS INFECTION IN ORAL CAVITY

“…Hyperbaric oxygen was given as the last therapy as a supportive and adjunctive therapy although HBO promoting wound healing and increasing phagocytosis (Mengji et al 2016). HBO is believed to improve neutrophilic killing by higher oxygen delivery and delaying or totally inhibiting the growth of fungal spores and mycelium (Sujatha et al 2011).…”