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硬腭毛霉菌病合并眶周肿胀的罕见病例:诊断难题

Rare case of hard palate mucomycosis complicated by peri-orbital swelling: A diagnostic challenge.

作者信息

Hamdulay Khadija F, Kumar Sunil, Acharya Sourya, Daiya Varun, Manuja Nishtha, Kothari Manjeet, Padwal Akshay M

机构信息

Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Sawangi, Meghe, Wardha, India.

出版信息

Radiol Case Rep. 2025 May 15;20(8):3744-3747. doi: 10.1016/j.radcr.2025.04.037. eCollection 2025 Aug.

Abstract

Mucormycosis is a rare but aggressive fungal infection predominantly affecting immunocompromised individuals. It presents significant diagnostic and therapeutic challenges, particularly when involving uncommon sites such as the hard palate and peri-orbital region. A 61-year-old male with a history of type II diabetes mellitus presented with peri-orbital swelling of the left eye, fever, and oral discomfort. His symptoms began following a dental extraction complicated by alveolar osteitis. Physical examination revealed a lesion on the hard palate, and laboratory tests indicated an underlying infection. MRI of the brain and orbits showed signal abnormalities consistent with an infectious process involving the preseptal and peri-orbital regions, with extension to the optic nerve and orbital muscles. Based on clinical, imaging, and medical history findings, a diagnosis of hard palate mucormycosis with peri-orbital involvement was established. The patient received intravenous meropenem, fluconazole, and insulin for diabetes management alongside symptomatic treatments. Gradual clinical improvement was noted, including a reduction in peri-orbital swelling and better oral intake. The patient was discharged with a continued plan for antifungal therapy and close diabetic monitoring. This case underscores the importance of early recognition and aggressive treatment of mucormycosis, especially in immunocompromised patients. A multidisciplinary approach, incorporating advanced imaging and comprehensive management of underlying conditions, is crucial in improving outcomes and reducing the high morbidity and mortality associated with this infection.

摘要

毛霉病是一种罕见但侵袭性的真菌感染,主要影响免疫功能低下的个体。它带来了重大的诊断和治疗挑战,尤其是当累及硬腭和眶周区域等不常见部位时。一名61岁的男性,有II型糖尿病病史,出现左眼眶周肿胀、发热和口腔不适。他的症状始于一次拔牙后并发牙槽骨炎。体格检查发现硬腭有病变,实验室检查表明存在潜在感染。脑部和眼眶的MRI显示信号异常,与累及眶隔前和眶周区域的感染过程一致,并延伸至视神经和眼肌。根据临床、影像学和病史检查结果,确诊为累及眶周的硬腭毛霉病。患者接受了静脉注射美罗培南、氟康唑以及用于糖尿病管理的胰岛素治疗,并进行了对症治疗。临床症状逐渐改善,包括眶周肿胀减轻和口腔摄入量增加。患者出院时继续接受抗真菌治疗方案,并密切监测糖尿病情况。该病例强调了早期识别和积极治疗毛霉病的重要性,特别是在免疫功能低下的患者中。采用多学科方法,结合先进的影像学检查和对基础疾病的综合管理,对于改善治疗效果和降低与这种感染相关的高发病率和死亡率至关重要。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6241/12144435/9ae4f5da2f4c/gr1.jpg

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