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[Rhino-orbito-cerebral mucormycosis: don't overlook direct examination!]

Imane Zouaoui1,2,3, Bay Yassine Bay1,2,3, Houda Doss-Bennani4,2,3

  • 1Laboratoire central de parasitologie-mycologie du Centre hospitalier universitaire Ibn Sina Rabat, Maroc.

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PubMed
Summary

Rhino-orbito-cerebral mucormycosis, a fungal infection, often affects diabetic patients. Early suspicion and treatment, as seen in a type 1 diabetes case, are crucial for successful outcomes.

Keywords:
Amphotericin BDiabetesInvasive fungal infectionMoroccoMucoralesMycological examinationNorth AfricaOpportunistic infection

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Area of Science:

  • Mycology
  • Infectious Diseases
  • Ophthalmology

Background:

  • Rhino-orbito-cerebral mucormycosis is the most common form of mucormycosis.
  • Diabetes, particularly with glycemic imbalance, is the most frequent underlying condition.
  • Prompt diagnosis and treatment are essential due to the severity of the infection.

Purpose of the Study:

  • To report a case of rhino-orbito-cerebral mucormycosis in a pediatric patient with type 1 diabetes.
  • To highlight the importance of considering mucormycosis in diabetic patients presenting with orbital cellulitis.
  • To emphasize the effectiveness of combined surgical and antifungal treatment.

Main Methods:

  • Case report of a 13-year-old female with type 1 diabetes and ketoacidosis.
  • Clinical and radiological assessment for orbital cellulitis (Chandler stages II-V).
  • Diagnosis confirmed by mycological and anatomopathological examinations post-surgery.
  • Treatment with liposomal amphotericin B.

Main Results:

  • The patient presented with progressive orbital cellulitis despite initial antibiotic and antifungal therapy.
  • Surgical debridement was necessary to remove necrotic tissue.
  • Diagnosis of mucormycosis was confirmed.
  • Successful treatment achieved with two months of liposomal amphotericin B.

Conclusions:

  • Rhino-orbito-cerebral mucormycosis should be suspected in diabetic patients with facial cellulitis.
  • Early diagnosis and aggressive management, including surgical intervention and appropriate antifungal therapy, are critical.
  • This case underscores the successful management of a severe fungal infection in a young diabetic patient.