Mucormycosis (MM) is a deep, opportunistic mycosis caused by filamentous fungi included in the order Mucorales that belong to the class Zygomycetes of fungi. It is recognized as one of the most rapidly progressive lethal form of fungal infection in human beings with a high mortality of 70–100%. The term osteomyelitis designates inflammation of the bone and its marrow cavity. Osteomyelitis and Mucormycosis have been known to be associated with intraosseous gas collection. However these have never been noted in the paranasal sinuses. These gas-forming infections can be caused by strict aerobic or facultative anaerobic bacteria such as Klebsiella, Escherichia coli, Salmonella, Streptococcus, and Staphylococcus. Their coexistence with fungal infections can lead to dreadful complications. This report highlights a rare case of Mucormycosis of the paranasal sinuses in an immunocompromised man with associated gas forming osteomyelitis of the facial bones. This report also emphasizes on the importance of a prompt and early management in such a condition due to the rapidly progressing bony osteomyelitis with gas- forming organisms that are co-existent with fungal infections along with a review of relevant literature. Introduction Mucormycosis (MM) is a deep, opportunistic mycosis caused by filamentous fungi included in the order Mucorales that belong to the class Zygomycetes of fungi. It is recognized as one of the most rapidly progressive lethal form of fungal infection in human beings with a high mortality of 70–100% .2,5 Among the conditions predisposing to MM are Diabetes Mellitus, malnutrition, haematological malignancies, neutropenia, burns, surgical procedures, occlusive dressings, antibiotics , long term steroid therapy and immunosuppressive therapy. 4 The term osteomyelitis designates inflammation of the bone and its marrow cavity.6 Osteomyelitis and Mucormycosis have been known to be associated with intraosseous gas collection. Intraosseous gas collection is usually observed in various pathologic conditions, including osteomyelitis due to certain gas-forming organisms (known as emphysematous osteomyelitis), osteonecrosis, postoperative and posttraumatic conditions.9 Bone involvement as a part of Mucormycosis is most commonly seen with the rhino cerebral form. Involvement of other bones such as femur, spine and temporal bones has also been reported in literature.4 However emphysematous changes associated with Mucormycosis induced osteomyelitis is thought to be extremely rare. The presence of gas forming osteomyelitis of the maxillary bones due to Mucormycosis of the paranasal sinuses has not yet been reported in literature. We present in this report a case of Mucormycosis of the naso-orbital region in a known diabetic with gas forming osteomyelitis of the facial bones with a review of relevant literature. Case report A 50 year old male farmer from a low socioeconomic, rural background presented to the emergency department of a tertiary referral centre in Bangalore, South India with a 10 days history of pain, swelling and progressive loss of vision in the right eye associated with a week long history of headache and facial pain. He was a diagnosed case of, poorly controlled, non insulin dependent diabetes mellitus (NIDDM) since 8 years on irregular treatment with oral hypoglycemic drugs. On clinical examination there was facial fullness over the cheek bones bilaterally. They were tender on palpation along with facial soft tissue crepitus. On Anterior rhinoscopy extensive foul smelling blackish crusts over the floor of the nasal cavity along with septal perforation involving the anterior part of the cartilage was seen. The oral cavity showed extensive erosion of the hard palate which was covered with foul smelling slough. A detailed ophthalmological examination confirmed total internal ophthalmoplegia with complete loss of vision and proptosis of the right eye. The left eye however maintained a normal visual acuity. Blood investi
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