A report of successfully treated rhino-orbital mucormycosis

Vincent Prasanna, Beulah Edwin, Shanthi Banukumar, Elango Dhanapal

Abstract


Rhino-cerebral mucormycosis is a rare life-threatening infection caused by fungi from the order Mucorales. The disease occurs mostly in association with diabetic ketoacidosis. Because of its rapid progression and high mortality, early recognition and aggressive treatment offer the only chance to increase the survival rate. We report a case of invasive mucormycosis in a 55 year old diabetic male, who presented with diabetic ketoacidosis and sinusitis. The patient came with complaints of swelling in right side of face, pain in right eye, right orbital swelling and numbness right cheek. An ENT examination revealed right facial swelling and proptosis. Nasal swabs were sent to microbiology for fungal culture. Material from the swab was inoculated on Sabaraud’s dextrose agar and incubated at 37°C and 25°C. The culture was identified as mucor species. Material sent for histopathology showed presence of chronic inflammatory polyp with broad aseptate hyphae suggestive of mucormycosis. On the third day, bilateral middle meatal antrostomy, bilateral anterior and posterior ethmoidectomy and bilateral wide sphenoidotomy was done. Fungal debris were noticed in both maxillary antrum. In the post-operative period, patient was started on inj. amphotericin B. On the 11th post-operative day, patient developed palatal mucosal necrosis. Under general anaesthesia, extensive surgical 2nd look and debridement was done. The necrotic palatal mucosa was completely removed. In addition to IV amphotericin B, topical douching of both nasal cavities and antrum with amphotericin B was done for 20 days. Patient improved, became completely asymptomatic and was discharged.

 


Keywords


Rhino-orbital mucormycosis, Diabetic ketoacidosis, Intranasal amphotericin B, Orbital decompression, Proptosis

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References


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