Shrestha Bibek, Shrestha Pradeep, Shrestha Prabin, Bastakoti Sudip, Gupta Prahlad, Magar Shiva Ram Ale
Institute of Medicine Maharajgunj Medical Campus, Tribhuvan University Kathmandu Nepal.
Department of Internal Medicine Tribhuvan University Teaching Hospital Kathmandu Nepal.
Clin Case Rep. 2024 Nov 12;12(11):e9491. doi: 10.1002/ccr3.9491. eCollection 2024 Nov.
Invasive fungal mucormycosis and its outcome as SIADH and orbital apex syndrome is uncommon. Mucormycosis in paranasal sinuses can even lead to intracranial invasion and its treatment with the use of amphotericin B can cure improve the prognosis of the disease. Early diagnosis and prompt treatment with antifungal, endoscopic surgery, and controlling of diabetes can be beneficial.
Mucormycosis is an opportunistic invasive fungal infection which is rare and fatal and can even cause intracranial invasion leading to SIADH. The infrequency with which mucormycosis with SIADH is encountered makes it a formidable diagnostic challenge. 70-year-old women uncontrolled diabetes mellitus presented with bilious vomiting and persistent headache with ptosis, proptosis, absence of extraocular movement, pupillary light reflex, and light perception of left eye. Radiographic investigation, KOH mount, and Biopsy showed mucormycosis in sinus with intracranial extension leading to SIADH. Further investigation revealed hyponatremia, decreased plasma osmolality. Then, when diabetes was controlled and hydrocortisone and amphotericin was given along with Endoscopic sinus debridement, SIADH was well controlled. This case illustrates the potential of mucormycosis in paranasal sinuses can even lead to intracranial invasion and its treatment with the use of amphotericin B can cure improve the prognosis of the disease. Prompt diagnosis through clinical history, radiological investigation, and laboratory parameters are important and its treatment is crucial for the better prognosis.
侵袭性真菌毛霉菌病及其导致抗利尿激素分泌异常综合征（SIADH）和眶尖综合征的情况并不常见。鼻窦毛霉菌病甚至可导致颅内侵犯，使用两性霉素B治疗可治愈并改善疾病预后。早期诊断并迅速进行抗真菌治疗、内镜手术以及控制糖尿病可能有益。
毛霉菌病是一种机会性侵袭性真菌感染，罕见且致命，甚至可导致颅内侵犯并引发抗利尿激素分泌异常综合征。毛霉菌病合并抗利尿激素分泌异常综合征的情况罕见，这使其成为一项艰巨的诊断挑战。一名70岁患有未控制糖尿病的女性出现胆汁性呕吐、持续性头痛，伴有上睑下垂、眼球突出、左眼眼球运动消失、瞳孔对光反射及光感消失。影像学检查、氢氧化钾涂片及活检显示鼻窦存在毛霉菌病并伴有颅内扩展，导致抗利尿激素分泌异常综合征。进一步检查发现低钠血症、血浆渗透压降低。随后，在控制糖尿病的同时给予氢化可的松和两性霉素，并进行内镜鼻窦清创术，抗利尿激素分泌异常综合征得到了良好控制。该病例表明鼻窦毛霉菌病甚至可导致颅内侵犯，使用两性霉素B治疗可治愈并改善疾病预后。通过临床病史、影像学检查和实验室参数进行快速诊断很重要，其治疗对于改善预后至关重要。
