1/51. Bronchial mucormycosis with progressive air trapping.A previously healthy 70-year-old woman developed fever, cough, and exertional dyspnea. Her symptoms progressed over a 2-month period despite treatment by her primary care physician with 2 courses of oral antibiotics and the addition of prednisone. Hypoxemia and the finding of hyperglycemia with mild ketoacidosis led to hospital admission. Serial chest radiographs demonstrated diffuse heterogeneous pulmonary opacities and progressive air trapping in the right lower lobe. Fiberoptic bronchoscopy revealed a deep penetrating ulcer with exposed bronchial cartilage of the bronchus intermedius and dynamic airway obstruction with complete closure during expiration. biopsy of the ulcer revealed rhizopus arrhizus. Respiratory failure stabilized with the patient on conventional mechanical ventilation and receiving amphotericin b. Before surgery could be performed, pseudomonas aeruginosa pneumonia and septic shock developed, and the patient died.- - - - - - - - - - ranking = 1keywords = ketoacidosis (Clic here for more details about this article) |
2/51. Rhinocerebral mucormycosis: a case of a rare, but deadly disease.Rhinocerebral mucormycosis is a rare fungal infection of the nasal cavity and sinuses that can spread to the orbits and cranium within days. Its presentation can be confused with those of sinusitis, viral infections, diabetic ketoacidosis, or carotid sinus thrombosis, and it is often missed at early presentation. survival is directly linked to early detection and treatment. We present a case of rhinocerebral mucormycosis and discuss the literature on its early signs and symptoms, pathophysiology, and treatment options.- - - - - - - - - - ranking = 1keywords = ketoacidosis (Clic here for more details about this article) |
3/51. Acute subdural hematoma and intracerebral hemorrhage. Rare complications of rhinocerebral mucormycosis.Rhinocerebral mucormycosis is a short-term and often rapidly lethal fungal disease. It is generally seen in uncontrolled cases of diabetes with ketoacidosis. This case exhibits many of the features of a typical fulminating rhinocerebral mucormycosis. However, the fatal complications of acute subdural hematoma and massive intracerebral hemorrhage due to rupture of aneurysm, as demonstrated by angiography, are unique clinical manifestations of patients with rhinocerebral mucormycosis.- - - - - - - - - - ranking = 1keywords = ketoacidosis (Clic here for more details about this article) |
4/51. Pulmonary mucormycosis in a diabetic patient.We present the case of a 54 year-old male from Moldavia with diabetes mellitus (type II diabetic), admitted to hospital in January 1999, with ketoacidosis and consolidation of the lower left lobe. The diagnosis of mucormycosis was confirmed by identification of large, nonseptate hyphae of the order mucorales. A strain of rhizopus oryzae (rhizopus arrhizus) was isolated from culture on sabouraud medium. The patient was treated by systemic amphotericin b, associated with surgical debridement (lobectomy).The treatment with amphotericin b was stopped after ten days and the patient was completely asymptomatic and returned to Moldavia. Mucormycoses are rare, and tend to be encountered in individuals with predisposing factors such as malignant blood disorders (immunocompromised patients) or diabetes mellitus. prognosis is poor, resembling infection with aspergillus, despite aggressive treatment as in the present case. The gravity of the condition can be accounted for by the thrombotic and necrosing nature of the fungal invasion of lung vessels.- - - - - - - - - - ranking = 1keywords = ketoacidosis (Clic here for more details about this article) |
5/51. Serous retinal detachment in a patient with rhino-orbital mucormycosis.BACKGROUND: Rhino-orbital mucormycosis is a difficult disease to treat. We report one case of rhino-orbital mucormycosis, complicated by serous retinal detachment, that responded to aggressive treatment. CASE: A 38-year-old man with diabetic ketoacidosis was referred to the emergency department of our hospital with fever, proptotic right eye, and complaint of lethargy. OBSERVATIONS: Fundus examination showed serous retinal detachment and focal lesions of retinitis with exudate at the inferior portion coincident with the position of opacification in the orbit on MRI. fluorescein angiography showed pooling of dye in the detached retina and leakage from focal lesions of retinitis. We thoroughly removed the large necrotic materials in the orbit and sinus through the lower conjunctiva without enucleation or exenteration. Microscopic examination and culture of the necrotic materials that were removed from the orbit proved that the patient had mucormycosis. The serous retinal detachment improved 10 days after orbital debridement combined with intravenous and local (intraorbital) amphotericin b treatment. visual acuity recovered to 20/50. CONCLUSION: We propose that inflammation of the sclera in close contact with necrotic fungi materials may cause serous retinal detachment.- - - - - - - - - - ranking = 1keywords = ketoacidosis (Clic here for more details about this article) |
6/51. Bilateral rhinocerebral phycomycosis.A 51-year-old diabetic woman developed bilateral rhinoorbitocerebral phycomycosis. Successful treatment was accomplished by correction of the ketoacidosis, surgical debridement, and amphotericin b therapy. Rhinoorbitocerebral phycomycosis is a fulminant and frequently fatal disease most often seen in debilitated hosts. This survival suggests that aggressive therapy is indicated in patients with extensive fungal involvement.- - - - - - - - - - ranking = 1keywords = ketoacidosis (Clic here for more details about this article) |
7/51. Rhinocerebral mucormycosis treated with 32 gram liposomal amphotericin b and incomplete surgery: a case report.BACKGROUND: mucormycosis (or zygomycosis) is the term for infection caused by fungi of the order mucorales. Mucoraceae may produce severe disease in susceptible individuals, notably patients with diabetes and leukemia. Rhinocerebral mucormycosis most commonly manifests itself in the setting of poorly controlled diabetes, especially with ketoacidosis. CASE PRESENTATION: A 31-year-old diabetic man presented to the outpatient clinic with the following signs and symptoms: headache, periorbital pain, swelling and loss of vision in the right eye. On physical examination his right eye was red and swollen. There was periorbital cellulitis and the conjunctiva was edematous. KOH preparation of purulent discharge showed broad, ribbonlike, aseptate hyphae when examined under a fluorescence microscope. Cranial MRI showed involvement of the right orbit, thrombosis in cavernous sinus and infiltrates at ethmoid and maxillary sinuses. mucormycosis was diagnosed based on these findings. amphotericin b (AmBisome(R); 2 mg/kg.d) was initiated after the test doses. Right orbitectomy and right partial maxillectomy were performed; the lesions in ethmoid and maxillary sinuses were removed. The duration of the liposomal amphotericin b therapy was approximately 6 months and the total dose of liposomal amphotericin b used was 32 grams. Liposomal amphotericin b therapy was stopped six months later and oral fluconazole was started. CONCLUSIONS: Although a total surgical debridement of the lesions could not be performed, it is remarkable that regression of the disease could be achieved with medical therapy alone.- - - - - - - - - - ranking = 1keywords = ketoacidosis (Clic here for more details about this article) |
8/51. Paranasal sinus mucormycosis: a report of two cases.mucormycosis of the nose and paranasal sinuses is a rare invasive fungal infection, which often has a very fulminant course and characteristic clinical findings. The patients are usually immunocompromised, with diabetic ketoacidosis being the commonest underlying disorder. In some immunocompetent patients, the disease is associated with local predisposing factors, such as chronic sinusitis. Although the prognosis has improved in recent decades, the disease can still be fatal. The underlying disease is an important determinant of prognosis and correction of the metabolic disorder, if present, is essential. Herein we report two cases: one of our patients was immunocompetent but had earlier suffered from polypous rhinosinusitis whereas the other had mild adult-type diabetes. Both patients were successfully treated with surgical debridement and amphotericin b.- - - - - - - - - - ranking = 1keywords = ketoacidosis (Clic here for more details about this article) |
9/51. A fatal case of gastric mucormycosis and diabetic ketoacidosis.OBJECTIVE: To describe a case of gastric mucormycosis in conjunction with severe bleeding in a young woman, which occurred after an episode of ketoacidosis and had a fatal outcome. methods: We present a case report, including detailed clinical and pathologic findings in a woman with gastric mucormycosis associated with severe bleeding. RESULTS: A 17-year-old woman sought medical assistance for diabetic ketoacidosis and severe epigastric pain. Chest radiography showed normal findings, and blood and urine cultures were negative for bacterial growth. endoscopy disclosed an extensive ulcerated lesion involving the greater curvature and posterior wall of the stomach. biopsy specimens demonstrated the presence of invasive mucormycosis. Treatment with amphotericin b was initiated, but severe persistent gastrointestinal bleeding resulted in the patient's demise. CONCLUSION: In conjunction with diabetic ketoacidosis, severe infection by Mucor has been reported mainly in the rhino-orbital area. Although uncommon, the gastrointestinal tract can also be involved. In the case described, severe hemorrhage ensued and caused the patient's death.- - - - - - - - - - ranking = 7keywords = ketoacidosis (Clic here for more details about this article) |
10/51. diabetic ketoacidosis and rhino-orbital mucormycosis.mucormycosis often develops in immunocompromised patients, particularly in patients with diabetic ketoacidosis. Unless early diagnosis and treatment is established mucormycosis leads rapidly to death. A 38-year-old woman was admitted to the hospital with a severe diabetic ketoacidosis. Her clinical status improved in 4 days as a result of aggressive medical treatment. She has complained left cheek pain on the 10th day and had a swelling of her left cheek, facial edema, a black eschar on the palate and nasal cavity in association with visual disturbance and total ophthalmology in a short time. CT scan revealed left orbital cellulitis and pansinusitis. Excessive surgical treatment was performed and liposomal amphotericin-B, 4 mg/(kg day) was applied. Extensive fungal invasion of the orbit and the sinuses was demonstrated in the pathological species and rhizomucor species were yielded with culture. Repeated superficial debridement was also performed. After 10 weeks, she was discharged with suggestion of insulin treatment and liposomal amphotericin-B with progressively decreasing doses. At the 13th month following the presentation, the patient was free of disease as confirmed by serial imaging and under good glycaemic control with insulin treatment. Although mucormycosis is a fatal infection, early diagnosis and aggressive treatment may decrease mortality.- - - - - - - - - - ranking = 6keywords = ketoacidosis (Clic here for more details about this article) |
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