Endocrine Abstracts

Background

Mucormycosis is an opportunistic fungal infection that can be aggressive and mortal. Diabetic ketoacidosis(DKA) is a risk factor for mucormycosis. We present a case with mucormycosis presenting with newly diagnosed diabetes mellitus and DKA.

Case presentation

A 34-year-old male patient presented with confusion and vomiting. He had no comorbiditiy. On admission the patient was afebrile, hypotensive (85/55 mm/hg) and had tachycardia (120/bpm). Laboratory investigations revealed hyperglycemia (673 mg/dl), severe metabolic acidosis (pH:6.86, bicarbonate:2.6 mmol/l) and urinary ketones. The patient was intubated due to cardiac arrest and followed up in the intensive care unit for 15 days. After that, the patient with newly diagnosed diabetes was admitted to our clinic for blood glucose regulation. During follow up, he described a feeling of swelling in the left half of the face and blurred vision. There was an erythematous appearance on the left eyelid. Diagnostic nasal endoscopy showed widespread crusting filling left nasal cavity and necrosis in the adjacent septum and middle meatus which was suggestive of mucormycosis. Paranasal sinus CT revealed mucosal thickening in the left frontal sinus, left anterior-posterior ethmoidal cells, sphenoid sinus in the left compartment and in the left maxillary sinus, causing almost complete loss of ventilation. Mucosal thickening was observed in the left compartment of the sphenoid sinus and the ethmoidal cells on the left. Left frontal and left sphenoethmoidal recesses were obliterated. Left precentral fatty tissue and left pterygopalatine fossa, around the sphenopalatine foramen were dirty. Orbital CT was normal. Cranial MRI showed 22 × 10 mm flair hyperintensity accompanied by effacement in the sulcus in left frontal lobe, frontobasal-orbitofrontal level, cortical-subcortical located in the medial part. In this location, frontal bone integrity was not clearly differentiated, and signs of inflammation were observed in the adjacent frontal sinus. The patient was operated urgently. Histopathology confirmed the diagnosis of mucormycosis. Liposomal amphotericin-B treatment was started. The patient was discharged with intensive insulin treatment after five weeks.

Conclusion

Mucormycosis is an invasive and progressive disease which requires immediate diagnosis and treatment including surgical debridement. Although uncontrolled and long standing diabetes is a well-known important risk factor for this opportunistic infection, it is rare to see it in patients with newly diagnosed diabetes. Our case is important in terms of showing that this infection can also occur in newly diagnosed diabetes.