Severe facial necrosis in a type 1 diabetic patient secondary to mucormycosis masquerading as an internal maxillary artery occlusion: a case report

BMC Infectious Diseases
Farheen ManjiBayan Missaghi

Abstract

Mucormycosis is a group of rare but life threatening angioinvasive infections caused by fungi of the order Mucorales that often occurs in immunocompromised patients and individuals with poorly controlled diabetes. Rhinocerebral mucormycosis can mimic sinusitis but can rapidly progress to deeper disease and cause facial necrosis. Facial vascular thrombosis is a rare complication of mucormycosis and can confound diagnosis of the disease. We report the case of a 25-year-old female with poorly controlled type 1 diabetes mellitus who initially presented with symptoms of sinusitis but rapidly progressed with signs of left-sided facial necrosis due to occlusion of the left internal maxillary artery. Early surgical debridement did not yield a microbiological diagnosis. Deeper surgical debridements ultimately revealed angioinvasive fungal disease consistent with mucormycosis. The patient recovered after repeated surgical intervention and aggressive parenteral antifungal therapy. This case illustrates an atypical complication of mucormycosis, and emphasizes that a high index of suspicion in vulnerable patient populations aids in the diagnosis of this life-threatening infection.

References

Jul 19, 2005·The British Journal of Oral & Maxillofacial Surgery·Jehn-Shyun HuangYing-Shiung Kuo
Mar 3, 2006·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·Jo-Anne H van BurikDimitrios P Kontoyiannis
Feb 11, 2011·Current Infectious Disease Reports·Brad Spellberg, Ashraf S Ibrahim
Jan 25, 2012·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·George PetrikkosDimitrios P Kontoyiannis
Mar 15, 2018·Medical Mycology·A SkiadaG Petrikkos
Oct 3, 2018·F1000Research·Benoit PilmisFanny Lanternier

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BETA
biopsy
biopsies

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