ENT and Head and Neck Surgery Department, La Timone Adults Hospital, Marseille, France.
Eur Ann Otorhinolaryngol Head Neck Dis. 2010 Mar;127(1):27-9. doi: 10.1016/j.anorl.2010.02.007. Epub 2010 Mar 30.
To present and discuss the case of a diabetic patient admitted with acidoketotic coma, with inner canthus tumefaction due to mucormycosis.
A 38-year-old diabetic man was admitted with acidoketotic coma and poor general health status. Clinical examination found right inner canthus tumefaction and mucopurulent rhinorrhea. Endoscopy of the nasal fossae found medial meatus sphaceluses. Sinus CT scan found a bilateral ethmoid infiltrating and osteolytic infectious process. Emergency endoscopic bilateral ethmoidectomy was performed. Mucormycosis was diagnosed, and liposomal amphotericin B was administered intravenously for 1 month then replaced by posaconazole. The patient was followed up monthly; the antifungal treatment was terminated after 8 months, the disease appearing to have resolved.
Mucormycosis is one of the most rapidly fatal fungal infections. Facial and cerebral CT scan is essential and is systematically abnormal in case of sinonasal mucormycosis. Emergency multidisciplinary treatment should address the diabetes and include rapid surgical debridement and effective antifungal medication. The reference antifungal is amphotericin B, to be administered at maximal dose (3 to 5 mg/kg per day). Posaconazole, available in Europe since July 2005, proved successful in the present case.
介绍并讨论一例糖尿病患者因毛霉病导致眼角肿胀入院，并发酸中毒性昏迷的病例。
一名 38 岁糖尿病男性因酸中毒性昏迷和全身健康状况不佳入院。临床检查发现右侧内眼角肿胀和脓性鼻漏。鼻道内镜检查发现中鼻道有腔隙性坏死。鼻窦 CT 扫描发现双侧筛窦浸润和溶骨性感染过程。紧急行双侧鼻内镜筛窦切除术。诊断为毛霉病，给予静脉注射脂质体两性霉素 B 1 个月，然后换用泊沙康唑。患者每月接受随访；8 个月后停止抗真菌治疗，疾病似乎得到缓解。
毛霉病是最致命的真菌感染之一。面部和脑部 CT 扫描必不可少，如果怀疑鼻-鼻窦毛霉病，CT 扫描通常异常。多学科联合紧急治疗应包括控制糖尿病，并迅速进行手术清创和有效的抗真菌治疗。参考抗真菌药物为两性霉素 B，应给予最大剂量（每天 3 至 5mg/kg）。泊沙康唑于 2005 年 7 月在欧洲上市，在本病例中证明有效。
