Endocrine Abstracts

Background: Mucormycosis, also known as black fungus, is a rare, aggressive, locally invasive, and life-threatening fungal infection that can occur in healthy individuals but that is more frequently seen in immuno-compromised patients especially in diabetics in the context of diabetic keto-acidosis. Early diagnosis is a key for good prognosis.

Case Presentation: We report the case of a 66-year-old Tunisian male, with a history of uncontrolled type 2 diabetes treated with metformin, who presented with fever, acute hemifacial and palpebral oedema and right unilateral epistaxis. The patient reported a 10-day history of dental pain initially diagnosed as a dental abscess and treated with amoxicillin. The initial presentation revealed a state of Keto-acidosis, adequate insulin therapy, as well as fluid and electrolyte replacement were initiated. An emergency CT scan revealed orbital cellulitis stage 2 of Chandler associated with cervical-facial extension without signs of collection, along with right maxillary and ethmoidal sinusitis, the patient was admitted and the diagnosis of dental-origin cellulitis with orbital extension was initially retained, the patient was placed under a triple antibiotic treatment, in 24 hours rapid lesion extension was noted with central necrotisation of skin lesions along with necrosis of the lateral wall of the right nasal cavity and ulceration of the right vestibular grove in nasal fibroscopy. Tissue samples were taken and an urgent pathological examination confirmed the diagnosis of Rhino-orbital mucormycosis precipitated by the state of keto-acidosis the patient was placed under anti-fungal treatment and surgical removal and care for necrotic lesions were done in the ENT department. Glycemia targets were met with intensive intravenous insulin treatment followed by a basal-bolus insulin regimen. Clinical improvement was noted in a few weeks and the patient benefited from a facial skin graft;

Conclusions: This case shows a rare case of rhinorobital mucormycosis precipitated by diabetic ketoacidosis and uncontrolled type 2 diabetes. This case highlights the need for an early diagnosis of mucormycosis as well as the need for optimal control of diabetes and rapid treatment of acute metabolic complications.