Rhino-orbito-cerebral mucormycosis in patients with uncontrolled diabetes: A case series

Abstract

Highlights Mucormycosis is a rare disease and is often fatal in the immunocompromised. We present a series of 3 patients with poorly controlled diabetes and mucormycosis. Diagnosing mucormycosis requires microbiologic and microscopic evidence. Combined medical and surgical management yields better outcomes for mucormycosis.

Mucormycosis in Different Clinical Settings: A Case Series

“…The initial symptoms of rhino-orbital-cerebral mucormycosis are consistent with either sinusitis or periorbital cellulitis, followed by the onset of conjunctival suffusion and blurry vision. Fever may be absent in up to half of the cases; leukocytosis is evident as long as the patient has functioning marrow [ 8 ]. The clinical manifestations of pulmonary mucormycosis are nonspecific.…”

Case report: Nasopharyngeal mucormycosis, atypical presentation in a seventy-year-old diabetic lady

“…Hyperglycemia, COVID-19, steroid use are the commonest cause factors of mucormycosis infections [13] , [14] , [15] , [16] , [17] , [18] .…”

Successful treatment of rhino-cerebral mucormycosis with dual antifungal therapy and minimal surgical debridement

“…Acidotic states promote the unbinding of iron from proteins leading to increased levels of serum iron which promotes fungal growth [25] . In addition to impaired iron sequestration, hyperglycemic states favor fungal growth through decreased phagocytosis associated with hyperglycemia [1] , [10] , [15] , [35] , [36] . Of those with diabetes, about 80% have type II, while about 20% have type I [7] , [9] , [14] , [18] , [24] , [26] , [33] , [36] , [37] , [38] , [39] .…”

“…Often the first signs of rhino-orbito-cerebral infection include ophthalmic signs, such as blindness, decreased visual acuity, diplopia, proptosis, and retroorbital pain [2] , [5] , [6] , [7] , [9] , [16] , [19] , [20] , [21] , [28] , [30] , [33] , [37] , [38] , [39] , [43] , [45] , [46] , or sinusitis commonly of the ethmoid and maxillary sinuses, including nasal congestion, epistaxis, and sinus tenderness [1] , [3] , [4] , [7] , [11] , [12] , [14] , [16] , [24] , [35] , [37] , [38] , [43] . Facial weakness, facial swelling, cranial nerve palsy, and facial pain are also typically present [2] , [4] , [5] , [6] , [9] , [11] , [16] , [19] , [20] , [21] , [28] , [30] , [32] , [35] , [37] , [39] , [41] , [43] . Other symptoms may include shortness of breath [37] , fever and chills [16] , [19] , [33] , [37] , headache [2] , [4] , [5] , [16] , [19] , [35] , [45] , and progression of symptoms despite treatment with antimicrobials [26] .…”

“…Facial weakness, facial swelling, cranial nerve palsy, and facial pain are also typically present [2] , [4] , [5] , [6] , [9] , [11] , [16] , [19] , [20] , [21] , [28] , [30] , [32] , [35] , [37] , [39] , [41] , [43] . Other symptoms may include shortness of breath [37] , fever and chills [16] , [19] , [33] , [37] , headache [2] , [4] , [5] , [16] , [19] , [35] , [45] , and progression of symptoms despite treatment with antimicrobials [26] . Confusion and altered mental status are often associated with cerebral involvement and indicate a later stage of disease, often indicating intracranial spread [3] , [6] , [19] , [28] , [31] .…”