Endocrine Abstracts

Introduction: Mucormycosis is a rare, devastating, fungal infection, which disproportionately affects non-controlled diabetic patients, notably during ketoacidosis. It is a potentially lethal disease. The diagnosis and treatment of mucormycosis remain a challenge because of the nonspecific clinical presentation. We discuss the clinical features and management modalities of this case.

Case: We report the observation of a 41 years old male patient, who had had type 1 diabetes mellitus for 21 years under insulin. He consulted the emergency room for diabetic keto-acidosis (DKA) on left unilateral orbital cellulitis of sudden onset. Clinically the patient was febrile with palpebral oedema, chemosis and painful ophthalmoplegia. The initial orbital CT scan was in favor of chandler stage 1 pre-septal cellulitis of the left eye with grade 1 exophthalmos probably of sinus origin. The patient was immediately put on parenteral tri-antibiotherapy with a worsening of the inflammatory signs clinically, biologically and by the extension on the CT scan of the cellulitis in the retro-septal area with ethmoidal and orbital abscesses complicated by septic thrombosis of the cavernous sinus and the internal carotid artery, intracerebral collections an. After mycological sampling of the inner part of the upper eyelid concluded to be Rhizopus microsporus. The patient benefited from endo-nasal surgical debridement and effective anticoagulation associated with liposomal amphotericin B for 10 days and then classical amphotericin B for 2 months. The subsequent evolution was favourable after broad surgical drainage, with disappearance of inflammatory signs, but blindness is definitive.

Discussion and Conclusion: Mucormycosis is a rare fungal infection that should be considered. The diagnosis, often difficult, must be made as early as possible. Poorly controlled diabetes mellitus is one of the main risk factors. The treatment, initiated as a matter of urgency, combines antifungal treatment, surgical debridement and correction of predisposing factors. The vital and functional prognosis remains severe in most cases.