Rhino-Maxillary Mucormycosis with Cerebral Extension: A Case Report and a Comprehensive Review of Literature

摘要

Mucormycosis is a rare opportunistic infection caused by fungus which belongs to the order Mucorales. A case of a male controlled diabetic patient with rhinocerebral mucormycosis is described. The patient had hemifacial swelling, nasal twang, febrile, sluggish, ocular signs and gross tissue destruction. Early recognition of mucormycosis is necessary to limit the spread of infection, which can lead to high morbidity and mortality. Therefore, health practitioners should be familiar with the signs and symptoms of the disease. Introduction Mucormycosis also called as Zygomycosis & Phycomycosis was first described by Paultauf in 1885 1 is an opportunistic frequently fulminating fungal infection that is caused by normal saprobic organisms of the class Zygomycetes including such genera as Mucor, Absidia, Rhizopus & Cunninghamella 2 .Numerous spores may be liberated into the air & inhaled by human hosts, from where it can spread to brain 3 . Only rarely has Zygomycetes been reported in apparently healthy individuals 2 . Infection commonly occurs in individuals with neutropenia, ketoacidotic diabetics 4 , malnutritioned, severe burns 5 , and hematological malignancies, patients under cancer chemotherapy or immunosuppressive drug therapy 3 . Initial signs being a nonspecific necrotic ulcer which turns later into a characteristic black necrotic eschar 6 . The purpose of this article is to report a case of Rhinocerebral Mucormycosis in an elderly diabetic male. A review of literature pertaining to mucormycosis of the maxillofacial region is also performed. Case Report A 60yr old patient presented to MMCDSR (Mullana) with a 3 month history of increasing midfacial pain, swelling around the right eye & pus discharge from the upper right back region of the jaw. He also encountered headaches and decreased vision in his right eye. His past medical history is significant only for diabetes & asthma since 20 yrs. His social history was significant for smoking tobacco, approximately 30-40 bidis/day since last 25yrs but discontinued the habit from past 1 year. On physical examination the patient is meekly responsive, sluggish in movements and febrile. The right eye was proptotic with chemosis, limitation of movement & decreased visual acuity. He had facial asymmetry with mild to moderate midfacial erythema & swelling over right side of midface, obliterating the nasolabial fold with tenderness. There is hoarseness and nasal twang in voice. Bilaterally submandibular lymphnodes & right upper deep cervical group were palpable but nontender. In the oral cavity there was denudation of the right maxillary oral mucosa with a swelling on the palate which pushed the whole mucosa towards the left side leaving denuded & naked bony sockets (Fig 1). The bare bone was visible from 18-22 and the lesion crossed midline. Buccal vestibular mucosa pertaining to right maxillary region was ulcerated & erythematous. Tenderness is also present. His laboratory findings were significant for a raised ESR of 74mm/hr, with random serum glucose, urea and creatinine under normal range.