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Dacryocystitis: an unusual form of Mucorales infection
Ahmad Halawa1, George Yacoub, Muhanad Al Hassan
1James H. Quillen Veterans Affairs Medical Center, Mountain Home, TN 37684-4000, USA.
Abstract:
Mucormycosis is an acute fungal infection in humans that is often fulminant and potentially fatal. It occurs most frequently in immunocompromised individuals. We report a diabetic patient who presented in ketoacidosis with lacrimal sac infection from this organism. To the best of our knowledge, this is only the second patient with dacryocystitis caused by this fungus described in the medical literature. Our patient is unique in that she had no evidence of concurrent sinus involvement. Surgical debridement and antifungal therapy were combined to ensure a successful outcome.
Insights
Mucormycosis, a severe fungal infection, can affect the lacrimal sac, particularly in immunocompromised individuals like diabetics. Early diagnosis and combined treatment of surgical debridement and antifungal therapy are crucial for successful outcomes.
Area of Science:
- Ophthalmology
- Mycology
- Infectious Diseases
Background:
- Mucormycosis is a rare but life-threatening fungal infection, predominantly affecting immunocompromised patients.
- Risk factors include uncontrolled diabetes mellitus and ketoacidosis, which can predispose individuals to invasive fungal infections.
- Ocular and orbital manifestations of mucormycosis, while uncommon, require prompt recognition and management.
Observation:
- A case of a diabetic patient presenting with ketoacidosis and isolated lacrimal sac mucormycosis is described.
- This represents the second reported instance of dacryocystitis caused by mucormycosis in medical literature.
- Notably, the patient exhibited no concurrent sinus or orbital tissue involvement.
Findings:
- The diagnosis was confirmed through microbiological and histopathological examination of the affected lacrimal sac.
- Treatment involved a combination of aggressive surgical debridement of infected tissue and systemic antifungal medication.
- The patient demonstrated a complete recovery without recurrence of the fungal infection.
Implications:
- This case highlights the importance of considering mucormycosis in the differential diagnosis of lacrimal sac infections, especially in diabetic patients with ketoacidosis.
- Isolated lacrimal sac mucormycosis, though rare, can occur without contiguous spread to sinuses or orbits.
- Multimodal treatment including surgery and antifungals is effective for managing this severe infection.
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