IADR Abstract Archives
Fungal Sinusitis in a Patient With Haematogenic Malignancy: Dissiminated Mucormycosis due to Rhizomucor Pusillus. a Case Report and Review of the Literature.
Objectives: The aim of our study is to report a case of a fungal sinusitis caused by Rhizomucor pusillus (R. pusillus) in an immunocompromised patient complicated with a progressive rhinocerebral mucormycosis, and to conduct a review of the literature to highlight the risk of developing invasive fungal infection in immunocompromised hosts.
Methods: Here, we report a case of a 34-year-old male with recent diagnosis of acute myelomonocytic leukemia and diabetes. The patient had history of dental abscess and gingivorrhagia which has led his dentist to investigate in his blood count. The CBC showed severe anemia (Hb=8g/dl), thrombocytopenia (platelets=27600/mm3) and neutropenia (WBC=3400/mm3). The patient was referred to the haematology department for appropriate management.
The patient received chemotherapy twice which have failed. Only days later the patient presented an altered general condition, severe facial edema with extensive necrotic lesions on the right side of the face and in the homolateral nasal cavity.
Results: Necrotic plaques extended to the right lower eyelid with total nasal obstruction. Direct microscopic examination from nasal swabs was positive and showed the presence of mycelial filaments. The mycological culture yielded a filamentous fungus of the order of Mucorales as R. pusillus. The patient went rapidly into a septic shock. High doses of amphotericin B were prescribed. The swelling persisted and the treatment was failing. The evolution for the patient was fatal.
The review of the literature revealed that fungal sinusitis in immunocompromised patient is frequent. Mucormycosis is commonly observed in these hosts and R.pusillus is one of the most incriminated fungi. The evolution is mostly lethal given the underlaying immunodepression.
Conclusions: Mucormycosis refers to opportunistic infections by filamentous fungi of the order of Mucorales such as R. pusillus. Diabetes in poor control is the most predisposing factor, however, patients with haematological malignancies may be infected. A thorough oral and dental examination is mandatory. It is also important to insist on a mycological examination for any similar aspects, to ensure early diagnosis and effective treatment to reduce mortality.
Methods: Here, we report a case of a 34-year-old male with recent diagnosis of acute myelomonocytic leukemia and diabetes. The patient had history of dental abscess and gingivorrhagia which has led his dentist to investigate in his blood count. The CBC showed severe anemia (Hb=8g/dl), thrombocytopenia (platelets=27600/mm3) and neutropenia (WBC=3400/mm3). The patient was referred to the haematology department for appropriate management.
The patient received chemotherapy twice which have failed. Only days later the patient presented an altered general condition, severe facial edema with extensive necrotic lesions on the right side of the face and in the homolateral nasal cavity.
Results: Necrotic plaques extended to the right lower eyelid with total nasal obstruction. Direct microscopic examination from nasal swabs was positive and showed the presence of mycelial filaments. The mycological culture yielded a filamentous fungus of the order of Mucorales as R. pusillus. The patient went rapidly into a septic shock. High doses of amphotericin B were prescribed. The swelling persisted and the treatment was failing. The evolution for the patient was fatal.
The review of the literature revealed that fungal sinusitis in immunocompromised patient is frequent. Mucormycosis is commonly observed in these hosts and R.pusillus is one of the most incriminated fungi. The evolution is mostly lethal given the underlaying immunodepression.
Conclusions: Mucormycosis refers to opportunistic infections by filamentous fungi of the order of Mucorales such as R. pusillus. Diabetes in poor control is the most predisposing factor, however, patients with haematological malignancies may be infected. A thorough oral and dental examination is mandatory. It is also important to insist on a mycological examination for any similar aspects, to ensure early diagnosis and effective treatment to reduce mortality.