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[Mucormycosis in paranasal sinuses]
Abstract:
Paranasal sinus mucormycosis is a rare and often fatal condition that occasionally occurs in patients with debilitating disease. Five mucormycosis cases with paranasal sinus involvement are reported. Two also complicated diabetes mellitus. These diabetic patients rapidly developed meningitis after the onset of symptoms. One case was soon operated upon and necrotic masses with fungus were excised. Despite i.v. amphotericin B administration, two patients lost their consciousness in a few days, relapsed into coma and died. In these cases, the infection originated from the ethmoidal sinus and directly spread towards the orbit and brain. The remaining three cases with mucormycosis had operations after the initial diagnosis of sinusitis. All of the three patients are alive and well. The combination of an excisional operation and antifungal therapy resulted in favorable response. High resolution CT scanning is valuable both in planning treatment and monitoring the response to therapy.
Insights
Paranasal sinus mucormycosis is a rare fungal infection. Early surgical intervention combined with antifungal therapy offers a favorable prognosis for patients, even those with diabetes mellitus.
Area of Science:
- Mycology
- Infectious Diseases
- Otolaryngology
Background:
- Paranasal sinus mucormycosis is a rare, life-threatening fungal infection.
- It primarily affects immunocompromised individuals, including those with uncontrolled diabetes mellitus.
- Early diagnosis and treatment are critical for patient outcomes.
Observation:
- Five cases of paranasal sinus mucormycosis were analyzed.
- Two cases involved patients with coexisting diabetes mellitus, who rapidly developed meningitis.
- Infection spread from the ethmoidal sinus to the orbit and brain in fatal cases.
Findings:
- Surgical excision of necrotic, fungal masses combined with intravenous amphotericin B was the treatment approach.
- Three patients who underwent timely surgery after initial sinusitis diagnosis recovered fully.
- Two diabetic patients who developed meningitis died despite treatment, indicating aggressive disease progression.
Implications:
- Prompt surgical debridement and antifungal therapy are crucial for treating paranasal sinus mucormycosis.
- High-resolution CT scanning aids in treatment planning and monitoring therapeutic response.
- Aggressive management is vital, especially in diabetic patients where rapid progression to meningitis can occur.