Rhinocerebral mucormycosis complicated by internal carotid artery thrombosis in a pediatric patient with type 1 diabetes mellitus: a case report and review of the literature.
OBJECTIVE
To illustrate that rapid diagnosis and aggressive treatment of rhinocerebral mucormycosis with internal carotid artery occlusion in a pediatric patient can prevent mortality and significant morbidity.


METHODS
Rhinocerebral mucormycosis infrequently occurs in the pediatric population, and when it involves thrombosis of an internal carotid artery, it has been almost uniformly fatal. We present an 8-yr-old girl with type 1 diabetes mellitus who has survived such an infection for 2 yr, and who has minimal residual morbidity. We believe she is the youngest patient to survive rhinocerebral mucormycosis complicated by internal carotid artery and cavernous sinus thromboses. She has survived with an intensive regimen including aggressive surgical debridement, amphotericin B, rigorous glucose control, hyperbaric oxygen therapy, interferon-gamma, posaconazole (an experimental antifungal), and granulocyte-macrophage colony-stimulating factor.


CONCLUSIONS
This article illustrates the importance of prompt recognition and aggressive treatment of fungal infection in patients with diabetes. Additionally, it emphasizes that such treatment can have an excellent outcome, and mortality and significant morbidity can be avoided. Finally, we provide a review of the literature regarding mucormycosis infections and treatment options.
Simmons
Jill H
JH
Barbara Davis Center for Childhood Diabetes, University of Colorado Health Sciences Center, Denver, CO, USA. jill.simmons@uchsc.edu
Zeitler
Philip S
PS
Fenton
Laura Z
LZ
Abzug
Mark J
MJ
Fiallo-Scharer
Rosanna V
RV
Klingensmith
Georgeanna J
GJ
D002341:Carotid Artery Thrombosis / Q000209:etiology* / Q000473:pathology / Q000628:therapy; D002426:Cavernous Sinus / Q000473:pathology; D002648:Child; D003131:Combined Modality Therapy; D003922:Diabetes Mellitus, Type 1 / Q000150:complications* / Q000628:therapy; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D009089:Mucor; D009091:Mucormycosis / Q000150:complications* / Q000473:pathology / Q000628:therapy*; D009915:Orbit / Q000473:pathology; D010256:Paranasal Sinuses / Q000473:pathology; D012852:Sinusitis / Q000150:complications* / Q000473:pathology / Q000628:therapy*; D013687:Telencephalon / Q000473:pathology