A Case of Successfully Treated Rhinocerebral Mucormycosis: Dental Implications

Abstract

This paper presents a case of rhinocerebral mucormycosis in a 22-year-old female patient with type I diabetes mellitus, who was successfully treated with surgery and long-term antifungal medication. The patient had initially been submitted to extraction of an upper third molar by a general dental practitioner but was referred to our department three days postoperatively because of double vision. Immediately following histopathological confirmation of the infection, the patient was administered Amphotericin B and Posaconazole intravenously. Surgical excision of the affected site was relatively conservative. The patient was free of the disease 15 months after initial admission to the hospital and has recently returned for reconstruction. The aim of this paper is to increase the awareness of general dental practitioners regarding uncommon serious conditions in diabetic patients, which may be confused with periodontal or dental diseases.

Rare opportunistic bread mold fungal infection of maxillary sinus in a diabetic patient

“…[ 2 ] This once it invades the arteries leads to thrombosis of the blood vessels and causes necrosis of the hard and soft tissues. [ 7 ] The pathophysiology of necrosis is depicted in Flow Diagram 1 . Upon entering the arteries, the fungus can also spread to orbit, lungs, and intracranial structures which can be fatal for the patient.…”

“…Upon entering the arteries, the fungus can also spread to orbit, lungs, and intracranial structures which can be fatal for the patient. [ 7 ]…”

“…It is very important to rule out aspergillosis as there is a lot of resemblances histologically between them. [ 7 ] Histologically, in aspergillosis, hyphae are septate and branching, whereas in mucormycosis, the hyphae are nonseptate, have a smaller width, and they branch at right angles [ 2 7 ] [ Figure 3 ]. CT is 100% sensitive and 78% specific in the diagnosis of sinonasal mycosis.…”

Mucormycosis in a diabetic ketoacidosis patient

“…CT and MRI are within normal limits initially, which are followed by signs of sinusitis, such as congested sinus or thickened mucosal lining. Repetition of the investigations is necessary for close follow-up of the advancement of the disease [10] .…”

“…The differential diagnosis of such a peculiar condition should initially include cocaine abuse, fasciitis, or other opportunistic infections of an immunocompromised host, such as aspergillosis, herpes simplex, or herpes zoster [10] .…”