Diabetes and infections
AD-0910

Woman with type 2 diabetes associated with rhinocerebral mucormicosis successful treatment
F.J. Lopez Maldonado1,2,3, V. Viridiana Barrientos Figueroa1,2, E.I. Marin Fregoso1, D.E. Paz Delgadillo1,2, D. Bazúa Sanches1, E. Casanueva Perez1,
1Universidad Autónoma de Baja California- Facultad de Medicina Mexicali, Mexicali, B.C., Mexico
2Hospital General de Mexicali, Mexicali, Mexico
3Hospital San Carlos, Mexicali, Mexico
4ISSSTECALI, Mexicali B.C., Mexico

Background
Mucormycosis is an invasive opportunistic infection, characterized by a rapid clinical course in which tissue necrosis develops as a result of tissue invasion and subsequent thrombosis. Its manifestations include the cerebral rhinoorbital, pulmonary, cutaneous, gastrointestinal, or disseminated form. Reports of the disease in healthy patients are rare, and risk factors for its development include diabetes with and without ketoacidosis, haematological malignancies (leukemia or lymphoma), patients with HIV infection, treatment with deferoxamine, high-dose glucocorticoid therapy , immunocompromised (neutropenia), intravenous (IV) drug users, solid organ transplantation and bone marrow, as well as extensive burns or major trauma. In recent years the report of this disease has increased in many countries, also high-income countries in patients with chronic uncontrolled diabetes, while in low-income countries, reports predominantly increase in patients with chronic uncontrolled diabetes. Current treatment techniques recommend the use of antifungal therapy, surgical surgical treatment, as well as modification of predisposing factors. Although amphotericin B and posaconazole in vitro activity against colonies of Mucorales, its clinical use is reserved on many occasions. Nephrotoxicity remains a common adverse effect of amphotericin B, and posaconazole has been studied primarily in therapeutic rescue scenarios.
Aim
To present an infectious disease associated with type 2 diabetes that has a high morbidity and mortality, which is relatively common in Latin America. A favorable outcome of the disease can be obtained by successful treatment in the early stages of the disease. We present the case of a sinusitis and brain abscess due to mucormycosis.
Method
Presentation of a case of rhinocerebral mucormycosis.
Results
A 53-year-old woman from Mexicali Valley, where she has lived all her life with a history of type 2 diabetes treated with metformin. Although the patient did not have a good attachment to her treatment and glucose monitoring. Her last hospitalization was one year ago for community-acquired pneumonia. She started a month ago with nasal congestion, nasal discharge accompaniment and frontal headache.

She came to the service due to the addition of intense frontal headache that did not yield with the use of analgesics, purulent nasal discharge, hyposmia, diplopia and right palpebral ptosis; physical exam show discrete right palpebral ptosis, 6mm pupils, mydriatic and poor right fotomotor reflex. At rhynoscopy, we founded turbinate hypertrophy, left mucopurulent rhinorrhea as well as hematic crust in the right meatus, with mucosa of the lateral wall violaceous and with pale air, normal rest. Computed Tomography was performed in which a hypodense image was observed towards the floor of the lobular frontal, bilateral ethmoid and maxillary sinusitis of aetiology to be determined, complemented by nasal biopsy and magnetic resonance imaging (MRI). A collection of ethmoidal and maxillary biopsy was performed, which in the pathology show the fragments of the respiratory mucosa and tissue with basophilic necrosis, and the longitudinal and transverse cuts of thick hyphae, 10-15 microns, stained with hematoxylin and eosin, with irregular branching, as well as in the stromal mucous glands and inflammatory lymphoplasmacytic infiltrate accompanied by neutrophil scales, as well as blood vessels with the wall infiltrated by neutrourophils and light colony by thrombi of fibrin, for which the histological diagnosis was defined as mucormycosis invasive. In MRI, the ethmoidal cell affection was bilaterally related to complicated mycosis with neuroinfection characterized by a predominantly bifrontal anomalous pachymeningeo thickening, with intra-axial abscess localized above olfactory groove in the right frontal lobe with vaso-genetic edema perilesional, in relation to the cerebral rhino mucormycosis.
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Discussion
Mucormycosis has poor prognosis with a mortality rate around 65%. The patient was given the accumulated dose of 2.5 g taking care of a possible renal damage, as well as administering potassium IV, as well 3 surgeries with multiple debridement. Due to the few cases reported in the literature on rhinocerebral mucromycosis, this is a case of medical relevance that already knows an original case of Mexicali in which the diligent multidisciplinary approach was the key to the success of the treatment. Finally, the evolution of the patient was favorable, presenting at adverse effects decreased visual acuity of the left eye.

Conflict of interest: No conflict of interest