El Hakkouni Awatif, Harrar Sara, Hachimi Abdelhamid, Mezouari Mostafa, Moutaj Redouane
Parasitology-Mycology Laboratory, Mohammed VI University Hospital, Marrakech, MAR.
Critical Care Medicine, Mohammed VI University Hospital, Marrakech, MAR.
Cureus. 2023 Sep 6;15(9):e44768. doi: 10.7759/cureus.44768. eCollection 2023 Sep.
Mucormycosis is a rare opportunistic fungal infection caused by and associated with high mortality rates. Rhino-orbito-cerebral localization usually occurs in individuals with uncontrolled diabetes mellitus. We report the case of a 41-year-old male, with previously undiagnosed diabetes, who presented with unilateral facial extensive black eschar and signs of diabetic ketoacidosis. Cerebral magnetic resonance imaging showed left pansinusitis, left craniofacial edematous infiltrate, and left proptosis. A left internal temporal abscess was identified at an early pre-suppurative stage. Magnetic resonance angiography revealed total occlusion of the left intracranial internal carotid artery. A histopathological study of nasal mucosa biopsy suggested mucormycosis. According to the clinical presentation and the radiological and histopathological findings, rhino-orbito-cerebral mucormycosis was presumed. Culture of nasal, ocular, and skin lesion specimens grew . and confirmed the diagnosis. The patient was treated with systemic liposomal amphotericin B. He died of multiple organ failure before surgical debridement was possible as he was in critical condition requiring stabilization before surgical treatment.
毛霉病是一种由罕见的机会性真菌感染引起的疾病，死亡率很高。鼻眶脑型毛霉病通常发生在糖尿病控制不佳的个体中。我们报告了一例41岁男性病例，该患者既往未诊断出糖尿病，出现单侧面部广泛黑色焦痂及糖尿病酮症酸中毒体征。脑部磁共振成像显示左侧全鼻窦炎、左侧颅面部水肿性浸润及左侧眼球突出。在早期化脓前期发现左侧颞叶内脓肿。磁共振血管造影显示左侧颅内颈内动脉完全闭塞。鼻黏膜活检的组织病理学研究提示为毛霉病。根据临床表现以及影像学和组织病理学检查结果，推测为鼻眶脑型毛霉病。鼻、眼及皮肤病变标本培养长出了 ，确诊了该病。患者接受了全身脂质体两性霉素B治疗。由于患者病情危急，需要在手术治疗前进行病情稳定处理，因此在可能进行手术清创之前死于多器官功能衰竭。
