amphotericin-b and Diabetic-Neuropathies

In a 70-year-old male patient with untreated diabetes a febrile orbital apex syndrome of rapid onset revealed a rhino-orbito-cerebral zygomycosis. Biopsies of the ethmoidal mucosa showed numerous colonies of the Rhizopus genus. Despite medical treatment (amphotericin B) and surgery (ethmoidectomy), the patient died within one week. Rhino-cerebral zygomycosis is a rare disease which occurs in diabetic and immunocompromised patients.

Topics: Aged; Amphotericin B; Diabetic Neuropathies; Ethmoid Bone; Ethmoid Sinusitis; Humans; Male; Mucormycosis; Orbital Diseases; Syndrome

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