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• W2048323388 abstract "Case report: We present the case of a 59-year-old white woman with a history of uncontrolled diabetes mellitus type 2 and hypertension who was admitted to our department because of persistent right hemifacial pain associated with homolateral periorbital edema, exophthalmos, ptosis and blurring of vision. A head CT scan showing complete destruction of the medial wall of the right maxillary sinus, sphenoidal sinus and nasal fossa involvement was performed at the onset of clinical manifestations, one month before hospital admission. Seven day antimicrobial treatment with ceftriaxone and moxifloxacin was implemented with no clinical benefit. The patient had been getting progressively worse with right visual field loss and increasing swelling. The patient underwent right sinus debridement and fluconazole plus cefotaxime were started. One week later a head-MRI scan evidenced complete right sinuses and homolateral extraocular muscle involvement. Another ethmoidectomy was performed and bioptic samples were sent for microscopic analysis. Therapy was empirically shifted to intravenous liposomal amphotericin B (L-AmB) and ceftriaxone. Blood tests showed elevation of inflammation markers, high fasting plasma glucose (332 mg/dl), abnormal glycated hemoglobin (12%), hypokalemia, increased serum creatinine (1.74 mg/dl) and blood urea nitrogen (77.3 mg/dl) levels. Fluid balance was carefully monitored to prevent acute renal injury and hypokalemia was corrected. Multi-injective insulin regimen was implemented. According to pathognomonic morphologic findings of right-angle branching irregular hyphae with only occasional septae, definitive diagnosis of mucormicosis was possible and posaconazole 400 mg bid on full meals was added. After 10 day-course of therapy, the patient was able to lift the eyelid up and periorbital edema was significantly reduced. Because of substantial increase in serum creatinine levels (up to 2.65 mg/dl) L-AmB was withdrawn deescalating therapy to posaconazole alone. After 26 days of hospital stay the patient was discharged. Clinical examination showed eyelid function recovery, complete resolution of periorbital edema but no visual field defect recovery. A head-MRI scan demonstrated improvement in extraocular muscle and retroorbital tissue involvement. After 12 month-course of antifungal therapy, posaconazole was discontinued. Discussion: Mucormycosis is an uncommon invasive fungal infection caused by ubiquitous fungi of the Mucorales order. Diabetes mellitus is considered a major risk factor. Rino-orbito-cerebral disease can be rapidly fatal with a mortality rate of 40% despite adequate antimicrobial treatment. In the past survival was critically linked to aggressive surgical procedures. Now, computed tomography and magnetic resonance imaging allow early diagnosis. This, combined with high dose antifungals, such as intravenous L-AmB, might reduce the importance of surgery. Oral posaconazole, alone or in combination with L-AmB, is currently reported to be effective for the treatment of mucormicosis and it could be considered as a possible adjunct or alternative to L-Amb in case of resistance or toxicity. Renal function, glucose levels (L-AmB must be diluted with 5% dextrose) and serum potassium must be closely monitored. Long-term antifungal regimens should be continued up to 12–18 months. Data are lacking and further studies are needed to evaluate duration of treatment regimens and clinical impact of posaconazole." @default.
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• W2048323388 date "2013-10-01" @default.
• W2048323388 modified "2023-09-26" @default.
• W2048323388 title "Not just a simple case of sinusitis" @default.
• W2048323388 doi "https://doi.org/10.1016/j.ejim.2013.08.519" @default.
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