Oral mucormycosis in an 18-month-old child: a rare case report with a literature review

Abstract

Oral mucormycosis is a fungal infection observed mainly in elderly immunocompromised patients. In rare instances, the disease occurs in healthy individuals and those patients that are below preschool age. Although this condition mainly involves the maxilla, it may also manifest in any part of the oral cavity based on the source of infection. Mucormycosis of the maxilla spreads rapidly, leading to necrosis of the palatal bone and palatal perforation. Such patients are usually rehabilitated using bone grafting or free flap surgeries. However, when surgeries are delayed, palatal prosthesis is an interim treatment modality that can prevent nasal regurgitation and aspiration of food or fluids. Palatal prostheses also help with mastication, speech, and swallowing. The present case describes a rare case of oral mucormycosis in an 18-month-old male involving the maxilla that was managed by palatal prosthesis.

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

“…Microscopically, aspergillosis has septate branching hyphae, whereas mucormycotic hyphae have smaller width and prominent acute angulations of branching hyphae. [ 3 ] In the present case, diagnosis was confirmed by histological examination of biopsy specimen using H and E, PAS, and GSM stains. Mucormycosis presents a nonspecific presentation clinically and radiographically; therefore, histopathology proves to be the “gold standard” for its diagnosis.…”

“…Rhinocerebral form is further subdivided into rhino-orbito-cerebral form which is invasive and may involve the ophthalmic and internal carotid arteries and rhino-maxillary form which involves the sphenopalatine and greater palatine arteries, resulting in thrombosis of the turbinate and necrosis of the palate. [ 3 7 ] Nearly 40%–70% of all reported cases manifest signs and symptoms involving facial and oral tissues. A black necrotic eschar is the most characteristic and pathognomonic lesion.…”

“…This causes invasion of the organism into the orbit and cranial vault leading to meningoencephalitis and cavernous sinus thrombosis, which may present as facial pain, swelling, orbital cellulituis, proptosis, loss of vision, ophthalmoplegia, necrosis of nasal turbinates and palate as well as osteomyelitis of facial bones. [ 3 ] Most reported cases of mucormycosis affecting facial region have been disseminated with orbital and cranial involvement. This is a rare localized form of mucormycosis.…”

Mucormycosis in immunocompetent patient resulting in extensive maxillary sequestration

“…Maxillary necrosis can occur due to bacterial osteomyelitis, herpes zoster, trauma, iatrogenic infections or fungal infections, such as mucormycosis and aspergillosis. [ 10 ] In our case report too, we came across exposed bone, clinically mimicking bacterial osteomyelitis but suggesting a different picture on histopathological examination.…”

“…Nevertheless, when deep tissues are invaded like in pulmonary mucormycosis cases, a correct diagnosis is more difficult to obtain. [ 10 ]…”