amphotericin-b and Diabetic-Coma

Zygomycosis (mucormycosis) is a rare, highly aggressive opportunistic fungal disease caused by saprophytic fungi, belonging to the division Zygomycota, class Zygomycetes. Patients with immunodeficiency, neutropenia, iron overload, hematological malignancies, as well as diabetics with ketoacidosis are typically affected.. Authors describe the case of an eighteen-year old man with poor compliance suffering from diabetes since the age of nine. He was admitted with ketoacidotic somnolence in severe general condition with unilateral periorbital erythematous edema. Though from nasal exudates gained by the fibero-endoscopic sinus surgery Methicillin-resistant Staphylococcus aureus and Pseudomas aeruginosa was cultured, amphotericin-B was administered as the medical history, clinical picture suggested presence of zygomycosis. An invasive infection caused by Rhizopus oryzae was confirmed by histology and microbiology.. The combination of antifungal therapy, repeated surgical interventions and granulocyte colony-stimulating factor resulted in good clinical response. Four month after discharge he is alive and doing well.

Topics: Adolescent; Amphotericin B; Antifungal Agents; Diabetes Complications; Diabetes Mellitus, Type 1; Diabetic Coma; Granulocyte Colony-Stimulating Factor; Humans; Magnetic Resonance Imaging; Male; Methicillin-Resistant Staphylococcus aureus; Pseudomonas aeruginosa; Pseudomonas Infections; Staphylococcal Infections; Zygomycosis

Reports in the literature of patients surviving mucormycosis involving the craniofacial structures are exceedingly rare. The necessity for early diagnosis by recognition of any of the six key signs and symptoms is emphasized. The futility of standard diagnostic tools, other than biopsy, is noted. An underlying debilitating condition such as diabetic ketoacidosis can predispose the patient to an acute infection by this usually nonpathogenic organism. The requirement for prompt treatment of the debilitating condition together with treatment to eradicate the fungus is stressed.

Topics: Abscess; Adult; Amphotericin B; Cavernous Sinus; Cranial Nerves; Dental Caries; Diabetes Complications; Diabetic Coma; Diabetic Neuropathies; Diagnosis, Differential; Face; Humans; Insulin; Lung Diseases; Male; Mucormycosis; Ophthalmoplegia; Pneumonia; Sinus Thrombosis, Intracranial; Skull; Tooth Diseases; Urinary Tract Infections

Topics: Adult; Age Factors; Aged; Amphotericin B; Blood Glucose; Bronchopneumonia; Cerebrovascular Disorders; Coronary Disease; Diabetic Coma; Diabetic Ketoacidosis; Female; Humans; Male; Middle Aged; Mucormycosis; Time Factors