Sinonasal Mucormycosis in a Diabetic - Case Report

Background : Mucormycosis is one of the rapidly progressing and lethal form of fungal infection which involves the nose and paranasal sinuses of the head and the neck regions. It manifests as rhinocerebral, sinonasal, pulmonary, gastrointestinal, cutaneous or disseminated form. The underlying conditions can influence clinical presentation and often delay diagnosis, with resultant poor outcomes. Objective: To present and discuss the case of a diabetic patient with sinonasal mucormycosis presented with facial pain and discolouration of right side of nose and face due to mucormycosis. Case report: A 23 years old female patient presented to emergency with uncontrolled blood sugars, pain and swelling over right side of face and blackish discolouration of right side of nose. On examination, there was bluish black discolouration of skin over right side of dorsum of nose and right ala of nose and right nasal vestibule. Sinus CT scan showed features suggestive of fungal sinusitis. Mucormycosis was suspected, confirmed with biopsy and surgical debridement and medial maxillectomy done. Intravenous amphotericin B was administered for 21 days. The patient was followed up regularly, the disease appearing to be resolved. Conclusion: Mucormycosis is a rapidly progressive fatal infection mostly reported in immune-compromised individuals. Emergency multidisciplinary treatment for control of blood sugars, surgical debridement and effective antifungal medications gives better clinical outcome.

New Treatment for Isolated Invasive Aspergillosis of Sphenoid Sinus in Immunocompetent Subjects: Sphenoid Nasalization Combined with Voriconazole / 대한이비인후과학회지

Isolated invasive fungal sinusitis of sphenoid sinus in a healthy immunocompetent person is extremely rare. Classical treatment of invasive fungal sinusitis is wide sphenoidotomy and surgical debridement combined with antifungal agents, mostly amphotericin B. We describe a case of a 72-year-old immunocompetent woman who presented with deep-seated orbital pain and was diagnosed as isolated invasive aspergillosis in sphenoid sinus invading orbital apex and cavernous sinus. This case was treated successfully with a new combination treatment of sphenoid nasalization and voriconazole, a new antifungal agent. There was no evidence of postoperative recurrence and side effects during the usage of voriconazole.

A Case of Invasive Fungal Sinusitis Accompanied with Inflammatory Pseudotumor in Skull Base / 대한이비인후과학회지

Skull base osteomyelitis typically arises as a complication of ear infection in older diabetic patients, but atypical skull base osteomyelitis arising from the sphenoid or occipital bones without external otitis can occur much less frequently and initially may present headache as the only symptom. Inflammatory pseudotumor is an idiopathic condition characterized by the sclerosing inflammation, which mimicks a neoplastic process. Inflammatory pseudotumor involving skull base and cervical spine is distinctly rare and usually indistinguishable from aggressive neoplasms or infection at these area. We report a case which was confirmed histologcally as invasive fungal sinusitis accompanied with inflammatory pseudotumor: the treatment consisted of amphotericin B and systemic steroid therapy but ended in a failure.