Moll G W, Raila F A, Liu G C, Conerly A W
Department of Pediatrics, University of Mississippi Medical Center, Jackson 39216-4505.
Diabetes Care. 1994 Nov;17(11):1348-53. doi: 10.2337/diacare.17.11.1348.
To describe the clinical course and the utility of computerized tomography (CT) and magnetic resonance imaging (MRI) in the successful management of an often fatal fungal infection in a 12-year-old patient with insulin-dependent diabetes mellitus (IDDM).
The patient was admitted to The University of Mississippi Medical Center (UMC) for the purpose of diabetic ketoacidosis (DKA) management and subsequent intensive therapy for mucormycosis according to nationally accepted standards of care. Strict diabetic control was instituted with frequent monitoring of blood glucose levels and interval assessment of HbA1c. Sequential MRI studies were obtained according to approved patient standards; the clinical and MRI course of the infection was charted.
The patient's DKA resolved within 12 h on intravenous fluid repletion and insulin therapy. His sinusitis/rhinitis noted on admission did not respond to intravenous antibiotic therapy and progressed with obvious left orbital involvement and left cranial nerve palsies by 72 h of hospitalization. CT and MRI were invaluable aids to the early diagnosis and design of appropriate surgical and antifungal management of this patient, who survived with minimal left cranial nerve palsies.
Our patient is among the youngest of IDDM patients reported to have survived rhinocerebral mucormycosis. His survival is attributed to early recognition of possible mucormycosis with diagnostic support of CT and MRI, surgical debridement and antifungal therapy, and intensive blood glucose control. Sequential MRI is invaluable to the design of therapy for this type of patient and shows the nearly 3-year recovery from mucormycosis.
描述计算机断层扫描（CT）和磁共振成像（MRI）在成功治疗一名12岁胰岛素依赖型糖尿病（IDDM）患者常致命的真菌感染中的临床过程及效用。
患者因糖尿病酮症酸中毒（DKA）入住密西西比大学医学中心（UMC），并根据国家公认的护理标准随后接受毛霉菌病强化治疗。通过频繁监测血糖水平和定期评估糖化血红蛋白A1c建立严格的糖尿病控制。根据批准的患者标准进行连续MRI研究；记录感染的临床和MRI过程。
患者的DKA在静脉补液和胰岛素治疗后12小时内得到缓解。入院时发现的鼻窦炎/鼻炎对静脉抗生素治疗无反应，并在住院72小时后进展为明显的左眼眶受累和左侧颅神经麻痹。CT和MRI对该患者的早期诊断以及适当的手术和抗真菌治疗方案的设计具有重要价值，该患者存活下来，仅遗留轻微左侧颅神经麻痹。
我们的患者是报告存活的鼻脑型毛霉菌病IDDM患者中最年轻的之一。他的存活归因于通过CT和MRI的诊断支持早期识别可能的毛霉菌病、手术清创和抗真菌治疗以及强化血糖控制。连续MRI对这类患者的治疗方案设计具有重要价值，并显示了从毛霉菌病中近3年的康复过程。
