1887
  1. Home
  2. A-Z Publications
  3. Qatar Medical Journal
  4. Volume 2021, Issue 3
  5. Article
Volume 2021, Issue 3
  • ISSN: 0253-8253
  • EISSN: 2227-0426

Abstract

Mucormycosis, a rare fungal infection, mainly affects individuals with diabetes mellitus and those who were immunocompromised and has a high mortality rate. Its most common presentation is similar to that of acute bacterial sinusitis with symptoms of nasal congestion, headache, and fever. The involvement of multiple cranial nerves in mucormycosis was rarely reported in the literature and indicates severe disease. Herein, we report the case of a 56-year-old man who was referred to the ophthalmology outpatient clinic for facial nerve palsy. He was treated with systemic steroids for 10 days with no improvement. On examination, he had a loss of vision and a frozen orbit due to involvement of cranial nerves II, III, IV, V, VI, and VII. An extensive workup revealed a hemoglobin A1C of 10%. However, he was never diagnosed with diabetes mellitus previously and denied any of the classical symptoms of diabetes mellitus. He underwent ethmoidectomy, maxillectomy, and drainage of an intraorbital abscess after appropriate imaging studies. Histopathology confirmed the diagnosis of mucormycosis, and the patient was started on systemic amphotericin B. This case emphasizes the importance of screening for diabetes mellitus. Early recognition of underlying diabetes mellitus in this patient may have prevented the development of mucormycosis along with its devastating complications.

© 2021 Al Saad, Rimawi, Saadeh, Shehadeh, licensee HBKU Press.
Loading

Article metrics loading...

/content/journals/10.5339/qmj.2021.61
2021-10-30
2024-11-05
Loading full text...

Full text loading...

/deliver/fulltext/qmj/2021/3/qmj.2021.61.html?itemId=/content/journals/10.5339/qmj.2021.61&mimeType=html&fmt=ahah

References

  1. Jiang N, Zhao G, Yang S, Lin J, Hu L, Che C, Wang Q, Xu Q. A retrospective analysis of eleven cases of invasive rhino-orbito-cerebral mucormycosis presented with orbital apex syndrome initially. BMC Ophthalmol. 2016 Dec 1; 16:(1):10.
     [Google Scholar]
  2. Prakash H, Chakrabarti A. Global epidemiology of mucormycosis. J Fungi (Basel). 2019 Mar; 5:(1):26.
     [Google Scholar]
  3. Roden MM, Zaoutis TE, Buchanan WL, Knudsen TA, Sarkisova TA, Schaufele RL, Sein M, Sein T, et al. Epidemiology and outcome of Zygomycosis: a review of 929 reported cases. Clin Infect Dis. 2005 Sep 1; 41:(5):634–53.
     [Google Scholar]
  4. Pandilwar PK, Khan K, Shah K, Sanap M, KS AU, Nerurkar S. Mucormycosis: A rare entity with rising clinical presentation in immunocompromised hosts. Int J Surg Case Rep. 2020 Jan 1;:77:57–61.
     [Google Scholar]
  5. Skiada A, Pavleas I, Drogari-Apiranthitou M. Epidemiology and diagnosis of mucormycosis: an update. J Fungi (Basel). 2020 Dec; 6:(4):265.
     [Google Scholar]
  6. Al Hassan F, Aljahli M, Molani F, Almomen A. Rhino-orbito-cerebral mucormycosis in patients with uncontrolled diabetes: A case series. Int J Surg Case Rep. 2020 Jan 1;:73:324–7.
     [Google Scholar]
  7. Bellazreg F, Hattab Z, Meksi S, Mansouri S, Hachfi W, Kaabia N, Said MB, Letaief A. Outcome of mucormycosis after treatment: report of five cases. New Microbes New Infect. 2015 Jul 1;:6:49–52.
     [Google Scholar]
  8. Jeong W, Keighley C, Wolfe R, Lee WL, Slavin MA, Kong DCM, Chen SC. The epidemiology and clinical manifestations of mucormycosis: a systematic review and meta-analysis of case reports. Clin Microbiol Infect. 2019 Jan; 25:(1):26–34. Doi:10.1016/j.cmi.2018.07.011. Epub 2018 Jul 21. PMID: 30036666.
     [Google Scholar]
  9. Gensler LS. Glucocorticoids: complications to anticipate and prevent. Neurohospitalist. 2013 Apr; 3:(2):92–7.
     [Google Scholar]
  10. Riga M, Kefalidis G, Danielides V. The role of diabetes mellitus in the clinical presentation and prognosis of Bell palsy. J Am Board Fam Med. 2012 Nov 1; 25:(6):819–26.
     [Google Scholar]
  11. Agha RA, Borrelli MR, Farwana R, Koshy K, Fowler AJ, Orgill DP, Zhu H, Alsawadi A, et al. The PROCESS 2018 statement: updating consensus preferred reporting of CasE series in surgery (PROCESS) guidelines. Int J Surg. 2018 Dec 1;:60:279–82.
     [Google Scholar]
  12. Ingley AP, Parikh SL, DelGaudio JM. Orbital and cranial nerve presentations and sequelae are hallmarks of invasive fungal sinusitis caused by Mucor in contrast to Aspergillus. Am J Rhinol. 2008 Mar-Apr; 22:(2):155–8. doi: 10.2500/ajr.2008.22.3141. PMID: 18416972.
     [Google Scholar]
  13. Sachdeva K. Rhino-oculo cerebral mucormycosis with multiple cranial nerve palsy in diabetic patient: review of six cases. Indian J Otolaryngol Head Neck Surg. 2013 Dec 1; 65:(4):375–9.
     [Google Scholar]
  14. American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2009 Jan 1; 32:(Supplement 1):S62–7.
     [Google Scholar]
  15. Ajlouni K, Batieha A, Jaddou H, Khader Y, Abdo N, El-Khateeb M, Hyassat D, Al-Louzi D. Time trends in diabetes mellitus in Jordan between 1994 and 2017. Diabet Med. 2019 Sep; 36:(9):1176–82.
     [Google Scholar]
/content/journals/10.5339/qmj.2021.61
Loading
Mucormycosis with extensive cranial nerve involvement as the first presentation of diabetes mellitus: A case report
Qatar Medical Journal 2021, 61 (2021); https://doi.org/10.5339/qmj.2021.61
/content/journals/10.5339/qmj.2021.61
/content/journals/10.5339/qmj.2021.61
Loading

Data & Media loading...

  • Article Type: Case Report
Keyword(s): cavernous sinus thrombosis, cranial nerve palsies, diabetes and Mucormycosis

Most Cited Most Cited RSS feed

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error