title: [Mixed fungal infection in a diabetic patient].
abstract: BACKGROUND
  Mixed fungal infections although undervalued, are more common than mentioned in the scientific literature. These infections have a poor prognosis for the patient.
  
  
  OBJECTIVE
  We present an unusual case of a 61-year-old diabetic male who had a rhino-orbito-sinusal zygomycosis in 2001. After surgical debridement of the infected parts, along with antifungal therapy with liposomal amphotericin B, the patient started improving. Several years later the patient was hospitalized due to a similar problem and was diagnosed of rhino-orbito-cerebral zygomycosis.
  
  
  METHODS
  In both episodes, a histopathological examination and cultures were performed on the sinus lesions. Tissue sections were stained with haematoxylin and eosin, Giemsa, periodic acid-Schiff (PAS) and Grocott's methenamine silver, and cultures specific for fungi were performed.
  
  
  RESULTS
  The histopathology studies revealed the presence of bacteria, actinomyces and a mixed infection by at least four different fungi, all of them well differentiated by their morphology. Despite the rapid diagnosis the patient died due to spreading to the central nervous system.
  
  
  CONCLUSIONS
  Mixed infections by fungi are rare, but due to the high incidence of immunodeficiencies they could occur more often than reported. We would like to alert on the possibility of acquired mixed infection by fungi which have shown to be high aggressive and have a worse prognostic in patients with underlying diseases.
authors.affiliation: Hospital Universitario Juan XXIII, Tarragona, España. emilio.mayayo@urv.cat
authors.forename: Emilio
authors.initials: E
authors.lastname: Mayayo
authors.forename: Clóvis
authors.initials: C
authors.lastname: Klock
authors.forename: Luciano Z
authors.initials: LZ
authors.lastname: Goldani
authors.forename: Ane C Zanella
authors.initials: AC
authors.lastname: Monteiro
authors.forename: Javier
authors.initials: J
authors.lastname: Capilla
mesh_terms: D048909:Diabetes Complications / Q000382:microbiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000382:microbiology*