Fatal case of antritis caused by mucormycosis in patient with diabetes mellitus

Abstract number: 1733_789

Tsoutsos S., Alexiou Z., Kallitsis A., Konstantopoulos P., Loukas T., Liappi G., Panoutsopoulos G.

Objectives: Mucormycoses are potentially fatal infections unless they receive immediate diagnosis, followed by surgical and pharmaceutical treatment.

Methods: Description of the case. M, 75 y.o., was admitted with symptoms of diabetic ketoacidosis and fever. He developed within 24 hours a strong headache, confusion, amaurosis of vision on both sides and aglutition.

Results: Physical examination findings: Edema and proptosis of orbits, opthalmoplegia on both sides. ENT examination found an extensive necrosis of the quadrangular septal cartilage, extending to the perpendicular plate of the ethmoid, enlargement of nasal chambers due to necrosis of the inferior and middle nasal conchae on both sides. An extended necrosis of the hard palate and inhibition of the pharyngeal rephlex were found from the orphopharynx. The CT imaging protocol: visceral cranium: Enlargement of nasal chambers to a large extent, both the anterior and posterior ethmoidal air cells, the sphenoid sinuses and the left antrum maxillare were affected, cerebral leukoencephalopathy lesions, microinfarcts of periventricular white matter, cerebellum atrophy. Thorax findings: ascending thoracic aorta aneurysm. Laboratory examination: WBC 18,900, PMN 89%, MO 7.5%, HCT 39.9%, ESR 124 mm, CRP 108 mg/dl, lgG 1,130 mg/dl, lgA 903 mg/dl, lgM 219 mg/dl, C3 167, C4 32.6. CSF examination: Protein <20 mg/dl, Glu 118 mg/dl, LDH 75, cells 35. The nasal mucosa tissue biopsy revealed a hyphomyces of the genus Mucor. Histological evaluation show necrotic changes of the superficial layers of the nasal mucosa and necrosis of many vessels caused by mucor. Alcian blue-PAS stain accentuated the wide-angle branching hyphae characteristic of mucor. Diabetic ketoacidosis and respiratory infection were treated with ceftriaxon and amphotericin B. Surgical treatment of the disease was contraindicated. The patient died 23 days after admission.

Conclusion: Prognosis of mucormycosis is not favourable despite early diagnosis and aggressive combined surgical and medical therapy.