Narayanan Santhosh, Panarkandy Geetha, Subramaniam Gomathy, Radhakrishnan Chandni, Thulaseedharan N K, Manikath Neeraj, Ramaswamy Sreejith, Radhakrishnan Suma, Ekkalayil Danish
Department of General Medicine.
Department of Radiodiagnosis.
Infect Drug Resist. 2017 Mar 28;10:103-108. doi: 10.2147/IDR.S130926. eCollection 2017.
Mucormycosis is a life-threatening infection affecting patients with diabetes. It is an angioinvasive disease often resistant to treatment with a debilitating course and high mortality. Here, we report a case of a 45 year old woman with type 2 diabetes mellitus who presented to us with history of right-sided ptosis and facial palsy, and subsequently developed loss of vision and palatal palsy. She was in diabetic ketoacidosis. Nervous system examination revealed involvement of right second, third, fourth, sixth, seventh, ninth, and tenth cranial nerves, suggestive of Garcin syndrome. The hard palate had been eroded with formation of black eschar. Computed tomography of paranasal sinuses revealed right maxillary and ethmoid sinusitis, with spread of inflammation to infratemporal fossa and parapharynygeal neck spaces. Debridement of sinus mucosa was done, and culture of the same yielded growth of rhizopus species. Histopathological examination of the tissue showed angioinvasion and fungal hyphae suggestive of mucormycosis. She was treated with amphotericin B, posaconazole, and periodic nasal sinus debridement, but her general condition worsened after 8 weeks due to secondary sepsis and she succumbed to death.
毛霉菌病是一种危及生命的感染，影响糖尿病患者。它是一种血管侵袭性疾病，通常对治疗耐药，病程迁延且死亡率高。在此，我们报告一例45岁2型糖尿病女性患者，她因右侧上睑下垂和面瘫前来就诊，随后出现视力丧失和腭瘫。她处于糖尿病酮症酸中毒状态。神经系统检查显示右侧第二、第三、第四、第六、第七、第九和第十颅神经受累，提示加欣综合征。硬腭已被侵蚀并形成黑色焦痂。鼻窦计算机断层扫描显示右侧上颌窦和筛窦炎，炎症蔓延至颞下窝和咽旁颈部间隙。进行了鼻窦黏膜清创术，培养结果显示有根霉菌生长。组织的组织病理学检查显示血管侵袭和真菌菌丝，提示毛霉菌病。她接受了两性霉素B、泊沙康唑治疗以及定期鼻窦清创术，但8周后由于继发脓毒症，她的一般状况恶化，最终死亡。
