Lethal rhinoorbital mucormycosis with intracranial spread

Introduction:

Mucormycosis is a rare disease that affects almost exclusively immunocompromised patients or patients with poorly controlled or unrecognized diabetes mellitus. Mostly a fulminant course of disease is reported. We present the case of a patient with untreated diabetes mellitus I (DM I) and a rapidly progressive mucormycosis.

Case report:

A 37-year-old patient presented in our emergency ambulance. He reported swelling and pain in the right midface. CT-scan showed acute sinusitis with a phlegmonous inflammation periorbital and maxillary. The next morning, the patient suffered from a ketoacidotic coma in DM I. In case of increased intraocular pressure, a transnasal orbital decompression and a trial biopsy were performed. There was no evidence of fungal infection in the histological examination. Nevertheless, antifungal therapy (amphomoronal i.v.) was started with reasonable suspicion. In the further course the general condition worsened and necroses formed in the right middle face as well as on the right hard and soft palate. Microbiologically, Rhizopus species grew. The planned orbital exenteratio and necrosis ablation was abandoned due to further deterioration of the patient's condition. Exitus letalis on day 15 of inpatient treatment.

Conclusion:

Despite the correct suspected diagnosis, mucormycosis also progressed in this case. It remains to be discussed whether an immediate exenteratio orbitae with radical necrosis ablation, despite the lack of pathological/microbiological evidence, could have prevented further invasion of the fungus.

Publication History

Publication Date:
23 April 2019 (online)