Endocrine Abstracts

Objectives: Mucormycosis is an opportunist infection usually affecting immunocompromised patients. It is rare and often fatal. The pathogen is filamentous fungus of the mucorales order. Transmission is air-borne, with predominantly sinonasal tropism (40% of cases). Other locations are possible but much rarer. Diagnosis is founded on anatomopathologic and mycologic examination. Prognosis is severe, depending essentially on early diagnosis and treatment. The present study and review of the literature updates clinical, paraclinical, evolutive and therapeutic aspects of ENT mucormycosis.

Material and methods: A retrospective study included 5 patients with ENT mucormycosis diagnosed over a 14-year period, from January 2006 to December 2019.

Results: The study included 2 male and 3 female patients, with a mean age of 45.6 years (range: 27-61 years). All patients were diabetic. Mean duration of diabetes was 10.6 years, with extremes ranging from 3 to 24 years. Complications related to diabetes were observed in 3 cases. A patient had advanced kidney failure and another had systemic lupus erythematosus. A glycaemic imbalance was noted in 100% of patients with a mean HbA1C of 8.78. All five patients had sinonasal mucormycosis. Imaging was performed for all patients. Computed tomography was performed in all cases and imagnetic resonance imaging in one case. Mucorales filaments were founded on anatomopathologic and mycologic examination. Liposomal amphotericin B was progressively initiated for many weeks, with surgical curettage in all cases. The equilibration of diabetes was obtained. Subsequent evolution was unfavorable in four cases and the patients died a few days after surgery, from severe sepsis and multi-organ failure.

Conclusions: Otorhinolaryngologic mucormycosis is a rare fungal infection, which needs to be borne in mind. Rhinocerebral lesions are the most common clinical manifestations. Diagnosis is often difficult, but should be as early as possible. Treatment, initiated urgently, associates antifungal treatment, surgical resection and control of risk factors. The prognosis remains in all cases severe.