Rhino-Orbital-Cerebral Mucormycosis with Diabetic Ketoacidosis

Abstract

Mucormycosis often develops in immunocompromised patients, particularly in patient with diabetic keto-acidosis. Unless early diagnosis and treatment is established mucormycosis leading rapidly to death.

A 54-years-old male was admitted to the hospital with a severe diabetic ketoacidosis. His clinical status improved in 3 days as a result of aggressive medical treatment. He has complained fever with right periorbital pain on the 7"‘ day and had a swelling of his right cheek, facial edema, a black eschar on the palate and nasal cavity, proptosis in association with visual disturbance and total opthalmoplegia in a short time.

CT scan revealed nearly total fluid filled at right maxillary sinus and little amount of air content, mucosal swelling right frontal and posterior ethmoid sinuses within invasion to right orbit, proptosis right globe without retrobulbar mass lesion, mucosal thickening right nasal cavity and small hypodensity lesion at right frontal lobe about1 x 1.4x 1.5cm. Excessive surgical treatment was performed and amphotericin-B 1 mg/kg/day. Small biopsy samples obtained from nasal eschar showed mucormycosis. However, his consciousness continued to decline and clinical condition show progressive deterioration. The patient finally expired six weeks after admission. Because of its rapid progression and high mortality.