title: The "black evil" affecting patients with diabetes: a case of rhino orbito cerebral mucormycosis causing Garcin syndrome.
abstract: Mucormycosis is a life-threatening infection affecting patients with diabetes. It is an angioinvasive disease often resistant to treatment with a debilitating course and high mortality. Here, we report a case of a 45 year old woman with type 2 diabetes mellitus who presented to us with history of right-sided ptosis and facial palsy, and subsequently developed loss of vision and palatal palsy. She was in diabetic ketoacidosis. Nervous system examination revealed involvement of right second, third, fourth, sixth, seventh, ninth, and tenth cranial nerves, suggestive of Garcin syndrome. The hard palate had been eroded with formation of black eschar. Computed tomography of paranasal sinuses revealed right maxillary and ethmoid sinusitis, with spread of inflammation to infratemporal fossa and parapharynygeal neck spaces. Debridement of sinus mucosa was done, and culture of the same yielded growth of rhizopus species. Histopathological examination of the tissue showed angioinvasion and fungal hyphae suggestive of mucormycosis. She was treated with amphotericin B, posaconazole, and periodic nasal sinus debridement, but her general condition worsened after 8 weeks due to secondary sepsis and she succumbed to death.
authors.affiliation: Department of General Medicine.
authors.forename: Santhosh
authors.initials: S
authors.lastname: Narayanan
authors.affiliation: Department of General Medicine.
authors.forename: Geetha
authors.initials: G
authors.lastname: Panarkandy
authors.affiliation: Department of Radiodiagnosis.
authors.forename: Gomathy
authors.initials: G
authors.lastname: Subramaniam
authors.affiliation: Department of General Medicine.
authors.forename: Chandni
authors.initials: C
authors.lastname: Radhakrishnan
authors.affiliation: Department of General Medicine.
authors.forename: N K
authors.initials: NK
authors.lastname: Thulaseedharan
authors.affiliation: Department of General Medicine.
authors.forename: Neeraj
authors.initials: N
authors.lastname: Manikath
authors.affiliation: Department of General Medicine.
authors.forename: Sreejith
authors.initials: S
authors.lastname: Ramaswamy
authors.affiliation: Department of Otorhinolaryngology, Government Medical College, Kozhikode, Kerala, India.
authors.forename: Suma
authors.initials: S
authors.lastname: Radhakrishnan
authors.affiliation: Department of General Medicine.
authors.forename: Danish
authors.initials: D
authors.lastname: Ekkalayil
keywords: diabetes; garcin syndrome; mucormycosis; rhinoorbitocerebral