Mucormycosis Mimicks Sinusitis in a Diabetic Adult

Abstract

Fungal sinusitis caused by invasive fungal infections, such as Mucormycosis, occurs predominantly in an immunocompromised patient. However, invasive cranial bone mycoses are rare and are usually associated with host immunodeficiency. They are difficult to diagnose, and in many cases are fatal. Treatment consists of antifungal chemotherapy, radical surgical debridement, and control of the underlying immunological condition. We report a case of Mucormycosis in a patient with type 1 diabetes mellitus. The patient had a history of dental pathology and associated renal dysfunction. The patient was managed by extensive surgical debridement followed by amphotericin B lipid complex injection (Abelcet 5 mg/bw kg/day) as an antifungal agent. Our patient's ocular function was affected. The radical treatment and follow-up by a multidisciplinary team eliminated the mucor-related consequences, however, the patient died because of end-stage renal failure. In conclusion, type 1 diabetes may be associated with invasive fungal sinusitis.

Successful Treatment of Invasive Rhinopulmonary Mucormycosis With an Indolent Presentation by Combined Medical and Surgical Therapy

“…Recently, there are some reports about increased cases of infection in immunocompetent patients because of medication abuse. 2 The reason why mucormycosis is common in groups with uncontrolled diabetes or diabetic ketoacidosis is that it has the enzyme ketone reductase. They are able to survive and grow in high glucose, acidic environments.…”

“…They are ubiquitous in soil, in vegetation, and in the air, making them frequent inhabitants of the upper airway mucosa but do not become a source of infection in healthy people. 2 They become pathogenic when the patient's general resistance has been altered.…”

The Rise of an oppurtunistic infection called "Invasive zygomycosis"

“…The classical form involves the sinuses, especially maxillary, but can easily spread to the neighboring tissue including nose, orbits, eyes, brain, cranial nerves, hard and soft palates, both mandibles and the rest of the face. It has great variety of clinical presentations from that of a simple acute sinusitis with purulent rhinorrhea,[58] where the initial exam of the nasal mucosa may be normal, to a more dramatic presentation caused by progressive thrombosis and infarction. The exam might reveal violaceous discoloration, black eschar or frank tissue necrosis.…”

Fatal Attraction! Fungus and Man

“…This rare, opportunistic fungal infection shows a rapidly progressive and fulminant course, often with fatal outcome (1,2). In 1800, Platauf described zygomycetes as pathogenic organisms causing disseminated disease in cancer patients.…”