OBJECTIVES: To present and discuss the case of a diabetic patient admitted with acidoketotic coma, with inner canthus tumefaction due to mucormycosis. CASE STUDY: A 38-year-old diabetic man was admitted with acidoketotic coma and poor general health status. Clinical examination found right inner canthus tumefaction and mucopurulent rhinorrhea. Endoscopy of the nasal fossae found medial meatus sphaceluses. Sinus CT scan found a bilateral ethmoid infiltrating and osteolytic infectious process. Emergency endoscopic bilateral ethmoidectomy was performed. Mucormycosis was diagnosed, and liposomal amphotericin B was administered intravenously for 1 month then replaced by posaconazole. The patient was followed up monthly; the antifungal treatment was terminated after 8 months, the disease appearing to have resolved. COMMENTS AND CONCLUSION: Mucormycosis is one of the most rapidly fatal fungal infections. Facial and cerebral CT scan is essential and is systematically abnormal in case of sinonasal mucormycosis. Emergency multidisciplinary treatment should address the diabetes and include rapid surgical debridement and effective antifungal medication. The reference antifungal is amphotericin B, to be administered at maximal dose (3 to 5 mg/kg per day). Posaconazole, available in Europe since July 2005, proved successful in the present case.
OBJECTIVES: To present and discuss the case of a diabeticpatient admitted with acidoketotic coma, with inner canthus tumefaction due to mucormycosis. CASE STUDY: A 38-year-old diabeticman was admitted with acidoketotic coma and poor general health status. Clinical examination found right inner canthus tumefaction and mucopurulent rhinorrhea. Endoscopy of the nasal fossae found medial meatus sphaceluses. Sinus CT scan found a bilateral ethmoid infiltrating and osteolytic infectious process. Emergency endoscopic bilateral ethmoidectomy was performed. Mucormycosis was diagnosed, and liposomal amphotericin B was administered intravenously for 1 month then replaced by posaconazole. The patient was followed up monthly; the antifungal treatment was terminated after 8 months, the disease appearing to have resolved. COMMENTS AND CONCLUSION:Mucormycosis is one of the most rapidly fatal fungal infections. Facial and cerebral CT scan is essential and is systematically abnormal in case of sinonasal mucormycosis. Emergency multidisciplinary treatment should address the diabetes and include rapid surgical debridement and effective antifungal medication. The reference antifungal is amphotericin B, to be administered at maximal dose (3 to 5 mg/kg per day). Posaconazole, available in Europe since July 2005, proved successful in the present case.