The Journal of Korean Diabetes 2009;10(1):57-61.
외상 후 이통을 주소로 내원한 제2형 당뇨병환자의 비-안와-뇌 뮤코르진균증 1예
최종수, 이해리, 강준구, 류옥현, 김철식, 이병완, 이성진, 김현규, 김두만, 유재명, 임성희, 최문기, 유형준, 홍은경
A Case of Rhino-Orbito-Cerebral Mucormycosis in Type 2 Diabetic Patient Presented as Posttraumatic Otalgia
Jong Soo Choi, Hae Ri Lee, Jun Goo Kang, Ohk Hyun Ryu, Chul Sik Kim, Byung Wan Lee, Seong Jin Lee, Hyeon Kyu Kim, Doo Man Kim, Jae Myung Yu, Sung Hee Ihm, Moon-Gi Choi, Hyung Joon Yoo, Eun-Gyoung Hong
Mucormycosis is a fatal, opportunistic infection by fungi Mucorales in immunocompromised patients. It progresses rapidly after infection, and mortality rate is very high despite of the combined management with extensive debridement of infective tissue and antifungal agent. A 69-year-old female patient with type 2 diabetes visited our hospital due to anorexia, otalgia on right side, and progressive hyperglycemia which were developed 5 days before admission after falling down. Mild facial swelling on the same side of trauma was developed after two days, and both maxillary and right ethmoidal sinusitis were observed by plain roentgenograms of the paranasal sinuses. Immediately after diagnosis of cellulitis and sinusitis, we started the intravenous ceftriaxone. However, the clinical status of patient progressively deteriorated even after the starting of antibiotics. So we did the functional endoscopic sinus surgery (FESS) for the confirmative diagnosis and treatment. Pathologic report from removed tissues of sinus and the findings of brain MRI with cerebral angiography showed typical findings of mucormycosis. We started intravenous amphotericin B, however, the patient expired due to progressive cerebral edema on the 42nd day after admission. Clinical course of mucormycosis is various in the immunocompromised patients including diabetes, and both aggressive diagnostic approach and management as early as possible are very important. We experienced a case of rhino-orbito-cerebral mucormycosis in type 2 diabetic patient who showed atypical clinical symptoms and signs, therefore proper diagnosis was delayed. So, here we report this special case with article review. (Korean Clinical Diabetes J 10:57-61, 2009)
Key Words: Fungal pseudoaneurysm, Rhino-orbito-cerebral Mucormycosis, Type 2 diabetes mellitus

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