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KMID : 0927720090100010057
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Korean Clinical Diabetes
2009 Volume.10 No. 1 p.57 ~ p.61
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A Case of Rhino-Orbito-Cerebral Mucormycosis in Type 2 Diabetic Patient Presented as Posttraumatic Otalgia
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Choi Jong-Soo
Lee Hae-Ri
Kang Jun-Goo
Ryu Ohk-Hyun
Kim Chul-Sik
Lee Byung-Wan
Lee Seong-Jin
Kim Hyeon-Kyu
Kim Doo-Man
Yoo Jae-Myung
Ihm Sung-Hee
Choi Moon-Gi
Yoo Hyung-Joon
Hong Eun-Gyoung
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Abstract
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Mucormycosis is a fatal, opportunistic infection by fungi Mucorales in immunocompromised patients. It progresses rapidly after infection, and mortality rate is very high despite of the combined management with extensive debridement of infective tissue and antifungal agent. A 69-year-old female patient with type 2 diabetes visited our hospital due to anorexia, otalgia on right side, and progressive hyperglycemia which were developed 5 days before admission after falling down. Mild facial swelling on the same side of trauma was developed after two days, and both maxillary and right ethmoidal sinusitis were observed by plain roentgenograms of the paranasal sinuses. Immediately after diagnosis of cellulitis and sinusitis, we started the intravenous ceftriaxone. However, the clinical status of patient progressively deteriorated even after the starting of antibiotics. So we did the functional endoscopic sinus surgery (FESS) for the confirmative diagnosis and treatment. Pathologic report from removed tissues of sinus and the findings of brain MRI with cerebral angiography showed typical findings of mucormycosis. We started intravenous amphotericin B, however, the patient expired due to progressive cerebral edema on the 42nd day after admission. Clinical course of mucormycosis is various in the immunocompromised patients including diabetes, and both aggressive diagnostic approach and management as early as possible are very important. We experienced a case of rhino-orbito-cerebral mucormycosis in type 2 diabetic patient who showed atypical clinical symptoms and signs, therefore proper diagnosis was delayed. So, here we report this special case with article review.
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KEYWORD
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Fungal pseudoaneurysm, Rhino-orbito-cerebral Mucormycosis, Type 2 diabetes mellitus
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