Rhinocerebral Mucormycosis in IDDM: Sequential magnetic resonance imaging of long-term survival with intensive therapy

Abstract

Our patient is among the youngest of IDDM patients reported to have survived rhinocerebral mucormycosis. His survival is attributed to early recognition of possible mucormycosis with diagnostic support of CT and MRI, surgical debridement and antifungal therapy, and intensive blood glucose control. Sequential MRI is invaluable to the design of therapy for this type of patient and shows the nearly 3-year recovery from mucormycosis.

COVID-19 associated rhino-orbital-cerebral mucormycosis: An observational study from Eastern India, with special emphasis on neurological spectrum

“… Radiological lesions over extraocular muscles, retro-orbital soft tissue, superior orbital apex, and cavernous sinus in clinically asymptomatic patients (no diplopia/external ophthalmoplegia) though infrequent, was present in some.This time gap probably represents the clinic-radiological dissociation, indicating the importance of imaging for earlier diagnosis and treatment initiation [ 38 ]. Clinically unilateral external ophthalmoplegia but radiologically bilateral extraocular muscles involvement were infrequent but deceptive, indicating radiological progression preceded clinical progression in few [ 39 ]. Bulbar dysfunction : Apart from subjects with destructive surgery, only few (five) had bulbar symptoms (nasal intonation and nasal regurgitation of liquid) due to palatal and pharyngeal muscles weakness, substantiated by imaging which showed intensity changes over palatal and pharyngeal muscles along with surrounding soft tissue, representing direct invasion of fungus.…”

“… Radiological lesions over extraocular muscles, retro-orbital soft tissue, superior orbital apex, and cavernous sinus in clinically asymptomatic patients (no diplopia/external ophthalmoplegia) though infrequent, was present in some.This time gap probably represents the clinic-radiological dissociation, indicating the importance of imaging for earlier diagnosis and treatment initiation [ 38 ]. Clinically unilateral external ophthalmoplegia but radiologically bilateral extraocular muscles involvement were infrequent but deceptive, indicating radiological progression preceded clinical progression in few [ 39 ]. …”

Current Perspectives on Ophthalmic Mycoses

“…Magnetic resonance imaging (MRI) and computerised tomography (CT) can help to establish an anatomical, if not pathological, diagnosis in suspected rhinocerebral fungal infections (213,252,302). Findings of diagnostic significance (in descending order of occurrence) include soft tissue opacification of sinuses with hyperdense material, nodular mucosal thickening, and an absence of fluid levels in different sinuses.…”

“…Findings of diagnostic significance (in descending order of occurrence) include soft tissue opacification of sinuses with hyperdense material, nodular mucosal thickening, and an absence of fluid levels in different sinuses. Sinus contents have a variety of MR signal characteristic, including T2 hyperintensity or marked hypointensity on all se- (252,323). Whether any specific radiological findings exist for rhinocerebral zygomycosis is a contentious point, although CT nonenhancement of the superior ophthalmic artery and vein, which is related to vasculitis and thrombosis, may represent one such specific sign (109).…”

European Society for Paediatric Endocrinology/Lawson Wilkins Pediatric Endocrine Society Consensus Statement on Diabetic Ketoacidosis in Children and Adolescents

“…27 Reported mortality rates from cerebral edema in population-based studies are 21% (C), 25 25% (C), 22 and 24% (B). 24 Significant morbidity is evident in 10% (C), 22 21% (B), 25 and 26% (B) 24 Other possible causes of mortality and morbidity include hypokalemia, hyperkalemia, hypoglycemia, other central nervous system (CNS) complications, hematoma (C), 30 thrombosis (C), 31 sepsis, infections (including rhinocerebral mucormycosis) (C), 32 aspiration pneumonia, pulmonary edema (C), 33 adult respiratory distress syndrome (C), 34 pneumomediastinum and subcutaneous emphysema (C), 35 and rhabdomyolysis (C). 36 Late sequelae relate to cerebral edema and other CNS complications including hypothalamopituitary insufficiency, 37,38 isolated growth hormone deficiency, 39 and combined growth hormone and thyroid-stimulating hormone deficiency.…”