Introduction:
Mucormycosis is a rare disease that affects almost exclusively immunocompromised patients
or patients with poorly controlled or unrecognized diabetes mellitus. Mostly a fulminant
course of disease is reported. We present the case of a patient with untreated diabetes
mellitus I (DM I) and a rapidly progressive mucormycosis.
Case report:
A 37-year-old patient presented in our emergency ambulance. He reported swelling and
pain in the right midface. CT-scan showed acute sinusitis with a phlegmonous inflammation
periorbital and maxillary. The next morning, the patient suffered from a ketoacidotic
coma in DM I. In case of increased intraocular pressure, a transnasal orbital decompression
and a trial biopsy were performed. There was no evidence of fungal infection in the
histological examination. Nevertheless, antifungal therapy (amphomoronal i.v.) was
started with reasonable suspicion. In the further course the general condition worsened
and necroses formed in the right middle face as well as on the right hard and soft
palate. Microbiologically, Rhizopus species grew. The planned orbital exenteratio
and necrosis ablation was abandoned due to further deterioration of the patient's
condition. Exitus letalis on day 15 of inpatient treatment.
Conclusion:
Despite the correct suspected diagnosis, mucormycosis also progressed in this case.
It remains to be discussed whether an immediate exenteratio orbitae with radical necrosis
ablation, despite the lack of pathological/microbiological evidence, could have prevented
further invasion of the fungus.
