Endocrine Abstracts

Introduction: Rhino-orbito-cerebral mucormycosis is a rare invasive fungal infection more common in diabetic and elderly patients. The presentation is acute, severe and rapidly progressive to disseminated infection. The diagnosis is done by the identification of risk factors, clinical and radiologic signs and tissue biopsy consistent with mucormycosis. The mortality rate is high, so timely diagnosis and intervention lead to better outcomes.

Clinical case: Male patient, 85-years-old, with a past medical history of diabetes type 2 medicated with Vildagliptin/Metformin 50/850 mg twice a day, hypertension, glaucoma and prostatic adenocarcinoma. With good metabolic control, as described in previous medical records. The patient was admitted to the emergency department because of right eye inflammation, epistaxis and nasal congestion over a period of 24 h. At physical examination he showed exophthalmia and right periorbitary edema. The plasmatic glycemia was 480 mg/dl and bioinflammatory parameters were elevated. The CT scan revealed: ‘Right ethmoidal-maxillary sinusitis and ipsilateral periorbitary cellulitis with post septal component’. The patient was admitted to ENT department and underwent nasal endoscopy and a biopsy was performed to remove tissue from the sites of infection for examination. Initially treated with antibiotic, later on switched to amphotericine B due to fungal disease confirmation. The histological examination was consistent with mucormycosis. During hospitalization the patient’s glucose levels improved. On the 5th day the clinical state aggravated and on the 16th day of hospitalization the patient died due to multi-organ dysfunction.

Discussion: This clinical case is relevant due to the gravity of the disease in the context of hyperglycemia. Owing to the increased number of newly diagnosed cases of mucormycosis worldwide resulting from uncontrolled metabolic conditions this is a disease to have in mind. Therefore any diabetic patient with sinonasal disease, regardless of metabolic control, should prompt evaluation to rule out mucormycosis.