title: Diabetic ketoacidosis and rhino-orbital mucormycosis.
abstract: Mucormycosis often develops in immunocompromised patients, particularly in patients with diabetic ketoacidosis. Unless early diagnosis and treatment is established mucormycosis leads rapidly to death. A 38-year-old woman was admitted to the hospital with a severe diabetic ketoacidosis. Her clinical status improved in 4 days as a result of aggressive medical treatment. She has complained left cheek pain on the 10th day and had a swelling of her left cheek, facial edema, a black eschar on the palate and nasal cavity in association with visual disturbance and total ophthalmology in a short time. CT scan revealed left orbital cellulitis and pansinusitis. Excessive surgical treatment was performed and liposomal amphotericin-B, 4 mg/(kg day) was applied. Extensive fungal invasion of the orbit and the sinuses was demonstrated in the pathological species and Rhizomucor species were yielded with culture. Repeated superficial debridement was also performed. After 10 weeks, she was discharged with suggestion of insulin treatment and liposomal amphotericin-B with progressively decreasing doses. At the 13th month following the presentation, the patient was free of disease as confirmed by serial imaging and under good glycaemic control with insulin treatment. Although mucormycosis is a fatal infection, early diagnosis and aggressive treatment may decrease mortality.
authors.affiliation: Department of Endocrinology, Cumhuriyet University, Medical School, 58140 Sivas, Turkey. idokmetas@yahoo.com
authors.forename: Hatice Sebila
authors.initials: HS
authors.lastname: Dökmetaş
authors.forename: Ercan
authors.initials: E
authors.lastname: Canbay
authors.forename: Sarper
authors.initials: S
authors.lastname: Yilmaz
authors.forename: Nazif
authors.initials: N
authors.lastname: Elaldi
authors.forename: Ayşen
authors.initials: A
authors.lastname: Topalkara
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Oztoprak
authors.forename: Esin
authors.initials: E
authors.lastname: Yildiz
mesh_terms: D000328:Adult; D000666:Amphotericin B / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D003404:Creatinine / Q000378:metabolism; D016883:Diabetic Ketoacidosis / Q000150:complications*; D005260:Female; D006801:Humans; D008081:Liposomes; D008279:Magnetic Resonance Imaging; D009091:Mucormycosis / Q000150:complications* / Q000000981:diagnostic imaging; D010038:Otorhinolaryngologic Diseases / Q000150:complications / Q000000981:diagnostic imaging / Q000382:microbiology*; D014057:Tomography, X-Ray Computed
chemical_list: D000935:Antifungal Agents; D008081:Liposomes; D000666:Amphotericin B; D003404:Creatinine