O'Brien T J, McKelvie P
Department of Clinical Neuroscience, St Vincent's Hospital, Melbourne.
Clin Exp Neurol. 1994;31:68-78.
Two cases of rhinocerebral mucormycosis in elderly, non-ketotic diabetics who were initially diagnosed and treated for bacterial periorbital cellulitis are reported. Both presented with a short history of periorbital pain and swelling followed rapidly by complete ophthalmoplegia and blindness. By the time of correct diagnosis, both cases were advanced with lower cranial nerve involvement, CT evidence of ophthalmic artery and cavernous sinus thrombosis and, in one, internal carotid artery invasion (demonstrated on MR angiography) with resultant cerebral infarction. One patient was treated with intravenous amphotericin B but died within a few days. The second patient had aggressive surgical resection and survived with significant residual morbidity. These cases illustrate that mucormycosis should be excluded in any diabetic patient presenting with orbital cellulitis, especially when there is early visual loss. Early aggressive treatment with surgery and antifungal agents is often successful whereas the outcome is almost universally fatal when the diagnosis is delayed.
本文报告了两例老年非酮症糖尿病患者发生鼻脑毛霉菌病的病例，这两名患者最初被诊断为细菌性眶周蜂窝织炎并接受治疗。两人均有眶周疼痛和肿胀的短暂病史，随后迅速出现完全性眼肌麻痹和失明。在正确诊断时，两例病情均已进展，出现了较低颅神经受累、眼动脉和海绵窦血栓形成的CT证据，其中一例（磁共振血管造影显示）颈内动脉受侵并导致脑梗死。一名患者接受了静脉注射两性霉素B治疗，但在数天内死亡。第二名患者接受了积极的手术切除，存活下来但有明显的残留病残。这些病例表明，任何患有眶周蜂窝织炎的糖尿病患者，尤其是出现早期视力丧失时，均应排除毛霉菌病。早期采用手术和抗真菌药物进行积极治疗往往会取得成功，而诊断延迟时，预后几乎普遍是致命的。
