Endocrine Abstracts

Purpose: Mucormycosis is a rare and potentially fatal invasive fungal infection which usually occurs in diabetic and other immunocompromised patients. This infection is associated with high morbidity and mortality rates. Prompt diagnosis and rapid aggressive surgical debridement and antimycotic therapy are essential for the patient’s survival. The purpose of this study was to expose the clinical feature, and to discuss the specificities management of mucormycosis in the setting of diabetes.

Material and Methods: This study was based on retrospective review of six diabetic patients who suffered from mucormycosis rhinisinusitis, over 22 years period (2000-2022).

Result: The mean age was 41 years with male predominance (4 males per 2 females), the average duration of diabetes follow up was over 10 years. We noticed an orbital involvement in one case. Rhinocerebral mucormycosis was diagnosed in one patient. The infection was limited to the rhinosinus space in 4 cases. The causative agent was, exclusively, Rhizopus arrhizus. Paranasal CT scan was performed for all our patients. In all cases, surgical evaluation was immediately performed for debridement of the necrotic tissues, and multiple biopsies were performed for diagnostic purposes. The medical treatment was based in intravenous liposomal amphotericin B. Nephrotoxicity were noted in 2 cases, with hepatic insufficiency in one of them. The main complication was septicaemia, seen in one case, after one week evolution. We noted a complete recovery in 5 cases. Despite an early diagnosis and rapid treatment the course of the disease has been marked by the death of one patient who had a cerebral involvement.

Conclusion: Mucormycosis rhinosinusitis is a disease with a rapid evolution and high morbidity and mortality rates, especially if there is an orbito – cerebral involvement. Therefore, it would be necessary in all diabetic patients, with sinus symptoms, headaches, visual changes, to suspect a mucormycosis, and perform immediately the appropriate surgical and medical management.