Management of fulminant mucormycosis of the maxillary sinus and orbit with an uncontrolled diabetic

Abstract

Introduction Mucormycosis of paranasal sinuses is a rare life-threatening opportunistic fungal disease that requires urgent treatment. The commonly involved are the immunosuppressed and immunocompetent patients. Patients are presented with facial or orbital cellulitis, necrotic palate, paresthesia of facial or trigeminal nerves and loss of vision, signs of meningitis. Radiological examinations are not sensitive in the early stages of infection. Definitive diagnosis is established by biopsy and histological examination of the necrotic tissue.

Case outline In August 2017, a 52-year-old female diabetic was admitted to the Clinic for Maxillofacial surgery due to the swelling and pain in the right side of the face, headache, fever, restriction of ocular movements, purulent rhinorrhea lasting for one week. Computed tomography examination showed spreading cellulitis of the right side of the face, total right maxillary end ethmoid sinus heterogeneous occupation and osteitis of the maxillary walls. Radical surgical debridement was performed. Histopathology and microbial tests were consistent with the finding of invasive mucormycosis. Liposomal amphotericin B 5mg/kg per day for four weeks was administered and patient’s glucose levels were controlled with injectable insulin and local status significantly improved. Patient was reoperated later due to the defect of the right maxilla.

Conclusion Early diagnosis and multidisciplinary approach including microbiology, pathology, radiology, surgery, hematology, infectious disease, intensive care and pharmacology is essential. Treatment of mucormycosis of paranasal sinuses requires prompt and aggressive treatment with antifungal agents, surgical debridement and control of predisposing factors.

Keywords: mucormycosis; paranasal sinuses; fungal infection; diabetes; opportunistic infection