Rhino-orbital-cerebral mucormycosis in type 1 diabetes mellitus.
OBJECTIVE
To describe the presentation and outcome of rhino-orbital-cerebral mucormycosis (ROCM) in adolescents with type 1 diabetes mellitus (T1DM).


METHODS
The medical records of six patients of T1DM with ROCM admitted between October 2001 to January 2004 were analysed.


RESULTS
The mean (+/- SD) age and duration of DM of these patients were 16.1+/-3.0 years and 26.3 +/- 24.9 months respectively. Four patients had ROCM at presentation, while two developed it during their hospital stay when recovering from diabetic ketoacidosis. Proptosis (100%) and ptosis (100%) were the most common symptoms, and ophthalmoplegia (85%) and vision loss (85%) were the most common signs. Maxillary sinus (85%) was the commonest paranasal sinus to be involved. All patients received amphotericin B and had appropriate surgery except one. Four patients survived. Patients who had altered sensorium, facial necrosis, palatal perforation and cerebral involvement at presentation had poor outcome.


CONCLUSIONS
High index of suspicion of ROCM in T1DM and combined approach with amphotericin B and appropriate surgery is rewarding.
Bhadada
S
S
Department of Endocrinology, PGIMER, Chandigarh, India.
Bhansali
Anil
A
Reddy
K S S
KS
Bhat
Rekha V
RV
Khandelwal
N
N
Gupta
A K
AK
D000293:Adolescent; D000328:Adult; D000666:Amphotericin B / Q000627:therapeutic use*; D000935:Antifungal Agents / Q000627:therapeutic use*; D002544:Cerebral Infarction / Q000209:etiology / Q000401:mortality; D002648:Child; D003922:Diabetes Mellitus, Type 1 / Q000150:complications* / Q000401:mortality; D017809:Fatal Outcome; D006801:Humans; D009091:Mucormycosis / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D009668:Nose Diseases / Q000209:etiology* / Q000628:therapy; D010349:Patient Compliance; D011379:Prognosis; D012189:Retrospective Studies
D000935:Antifungal Agents; D000666:Amphotericin B