Fulminant Mucormycosis Involving Paranasal Sinuses: A Rare Case Report

Abstract

Mucormycosis is an opportunistic fulminant fungal infection, which has the ability to cause significant morbidity and frequently mortality in the susceptible patient. Common predisposing factors include diabetes mellitus and immunosuppression. The infection begins in the nose and paranasal sinuses due to inhalation of fungal spores. The fungus invades the arteries leading to thrombosis that subsequently causes necrosis of the tissue. The infection can spread to orbital and intracranial structures either by direct invasion or through the blood vessels. Here we describe a case of mucormycosis of maxillary antrum extending to ethmoidal and frontal sinus and also causing necrosis of left maxilla in an uncontrolled diabetic individual to emphasize early diagnosis and treatment of this fatal fungal infection.

Literature Review: HYPERBARIC OXYGEN THERAPY ON MUCORMYCOSIS INFECTION IN ORAL CAVITY

“…Prognosis involves high morbidity and mortality and may improve with rapid diagnosis, early management, and reversible underlying risk factors. Survival rates among groups of patients with invasive sinus disease without cerebral involvement may be as high as 50 -80%; if infection spreads to the brain, case fatality ratio exceed 80%.The authors propose that oral physician should be aware of the novel perspectives of the disease for early diagnosis and management (Garlapatti et al 2014). Recently intravenous liposomal Amphotericine, intravenous lipid complex and Hyperbaric oxygen therapy has also been used (Vijaya-bala et al 2013)…”

“…Mucormycosis is the third invasive mycosis in order of importance after candidiasis and aspergillosis and is caused by fungi of the class Zygomycetes. The most impotant species in order of frequency is Rhyzopus arrhizus (oryzae) (Garlapatti et al 2014).…”

Rhinocerebral mucormycosis associated with actinomycosis in a diabetic patient: A rare presentation

“…The infection can spread to orbital and intracranial structures either by direct invasion or through the blood vessels. [ 5 ] The fungus invades arteries leading to thrombosis that subsequently causes necrosis of hard and soft tissues. [ 6 ]…”

The Expression of VEGF-A in Maxillary Mucosal Tissue of Mucormycosis Infection on Dental Extraction after Hyperbaric Oxygen Therapy

“…7 The most impotant species in order of frequency is Rhyzopus arrhizus (oryzae). 8 The use of hyperbaric oxygen as adjunctive treatment for Zygomycosis has been reported since 1970s and hyperbaric oxygen treatment is usually well tolerated and is associated with low risk of adverse events. 9 Hyperbaric oxygen therapy has been used as an adjunct to aggressive surgical debridement, amphotericin B therapy , control of any underlying predisposing conditions by aiding neovascularization and subsequent healing .…”

“…5 Hyperbaric oxygen therapy has also been used to treat mucormycosis. 8 VEGF (Vascular endothelial growth factor), a glycoprotein, has attracted attention as a potential inducer of angiogenesis. It is detectable in periodontal tissues within endothelial cells, plasma cells, and macrophages and in junctional, sulcular, and gingival epithelium.…”