Aggarwal Aakash, Arora Ripu Daman, Nagarkar Nitin M, Banjare Amit
Department of ENT and Head Neck Surgery, All India Institute of Medical Sciences, Raipur, Chhattisgarh 492099 India.
Indian J Otolaryngol Head Neck Surg. 2024 Feb;76(1):1033-1036. doi: 10.1007/s12070-023-04096-3. Epub 2023 Jul 31.
A Gentleman in his 40s presented to us with left-sided hemifacial pain and nasal discharge for the last three days. He has been on immunosuppressive therapy for Wegener's Granulomatosis for over five years. Crusting was seen in the Left middle meatus upon clinical examination. Based on the post-covid status, steroid therapy, KOH mount, and radiologic imaging, a provisional diagnosis of Sinonasal mucormycosis was considered. He was posted for emergency debridement followed by Liposomal Amphotericin B and steroid therapy. Surgical histopathological specimens were suggestive of Mucormycosis. Limited sinonasal disease with no intracranial, orbital, or palatal involvement was seen in a background of Wegener's Granulomatosis, Covid, and immunosuppressive therapy. Steroids are condemned as a predisposing factor to mucormycosis. Still, the combination of Liposomal Amphotericin B and steroids was used, opening new avenues for managing mucormycosis in patients with vasculitis. The patient is well nine months post-surgery with no signs of disease relapse.
一名40多岁的男性在过去三天里出现左侧面部疼痛和鼻分泌物。他因韦格纳肉芽肿接受免疫抑制治疗已超过五年。临床检查发现左侧中鼻道有结痂。根据新冠感染后的状况、类固醇治疗、氢氧化钾涂片及影像学检查，初步考虑诊断为鼻-鼻窦毛霉菌病。他被安排进行紧急清创术，随后接受脂质体两性霉素B和类固醇治疗。手术组织病理标本提示为毛霉菌病。在韦格纳肉芽肿、新冠感染和免疫抑制治疗的背景下，可见鼻窦疾病局限，无颅内、眼眶或腭部受累。类固醇被认为是毛霉菌病的诱发因素。然而，脂质体两性霉素B和类固醇的联合使用，为血管炎患者毛霉菌病的治疗开辟了新途径。该患者术后九个月情况良好，无疾病复发迹象。
