title: Rhinocerebral mucormycosis in a patient with type 1 diabetes presenting as toothache: a case report from Himalayan region of India.
abstract: Mucormycosis is an angioinvasive infection caused by ubiquitous filamentous fungi of the order Mucorales. It is a rapidly progressive fatal infection mostly reported in susceptible individuals, such as those with poorly controlled diabetes or those with defects in phagocytic function. Rhinocerebral mucormycosis is the most common type of mucormycosis in diabetic patients. This case report describes a 17-year-old girl with type 1 diabetes mellitus presenting with rhinocerebral mucormycosis. The patient presented with a history of toothache and facial pain with oedema of left half of face, periorbital oedema and depressed conciousness. She had hyperglycaemia with diabetic ketoacidosis and rapidly developed hemiparesis progressing to quadriparesis and died within 3 days of admission. The current report emphasises the importance of having a high index of suspicion when dealing with patients with diabetes presenting with facial pain or cellulitis and prompt initiation of medical therapy along with surgical debridement for control of rhinocerebral mucormycosis.
authors.affiliation: All India Institute of Medical Sciences, Jodhpur, Rajasthan, India.
authors.forename: Vikram
authors.initials: V
authors.lastname: Singh
authors.forename: Mridu
authors.initials: M
authors.lastname: Singh
authors.forename: Chitra
authors.initials: C
authors.lastname: Joshi
authors.forename: Jyoti
authors.initials: J
authors.lastname: Sangwan
mesh_terms: D000293:Adolescent; D000666:Amphotericin B / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003646:Debridement / Q000379:methods; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy / Q000276:immunology; D016883:Diabetic Ketoacidosis / Q000175:diagnosis* / Q000188:drug therapy; D018450:Disease Progression; D004636:Emergency Service, Hospital; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D007194:India; D009091:Mucormycosis / Q000150:complications / Q000175:diagnosis* / Q000276:immunology / Q000628:therapy; D010254:Paranasal Sinus Diseases / Q000150:complications / Q000175:diagnosis* / Q000276:immunology / Q000628:therapy; D018570:Risk Assessment; D012424:Rural Population; D012720:Severity of Illness Index; D014098:Toothache / Q000175:diagnosis* / Q000209:etiology
chemical_list: D000935:Antifungal Agents; D000666:Amphotericin B