Mucormycosis is an opportunistic fulminant fungal infection, which has the ability to cause significant morbidity and frequently mortality in the susceptible patient. Common predisposing factors include diabetes mellitus and immunosuppression. The infection begins in the nose and paranasal sinuses due to inhalation of fungal spores. The fungus invades the arteries leading to thrombosis that subsequently causes necrosis of the tissue. The infection can spread to orbital and intracranial structures either by direct invasion or through the blood vessels. Here we describe a case of mucormycosis of maxillary antrum extending to ethmoidal and frontal sinus and also causing necrosis of left maxilla in an uncontrolled diabetic individual to emphasize early diagnosis and treatment of this fatal fungal infection. 1. Introduction Mucormycosis (phycomycosis, zygomycosis) is a rare opportunistic infection caused by fungi belonging to the Mucorales order and the Mucoraceae family [1]. Mucormycosis was first described by Paultauf in 1885 [1]. It is recognized as one of the most rapidly progressive lethal form of fungal infection in human beings with a high mortality of 70–100% [2]. The most commonly reported form of the disease is rhinocerebral mucormycosis, which is characterized by progressive fungal invasion of the hard palate, paranasal sinuses, orbit, and brain [3]. It can be subdivided into rhinomaxillary and rhino-oculocerebral forms, the latter being characterized by a high mortality rate [1]. The conditions predisposing to mucormycosis are diabetes mellitus, malnutrition, haematological malignancies, neutropenia, burns, surgical procedures, occlusive dressings, antibiotics, long-term steroid therapy, and immunosuppressive therapy [2]. Successful management of this fulminant infection requires early recognition of the disease and aggressive medical and surgical interventions to prevent the high morbidity and mortality associated with the disease process [3]. We report a case of mucormycosis causing maxillary necrosis with involvement of left side maxillary, ethmoidal, and frontal sinuses. 2. Case Report A 40-year-old female patient presented with dull pain and purulent discharge in left posterior maxillary teeth region since 6 months following the extraction of teeth (24, 25, 26, 27, and 28). She presents history of dull aching pain with intermittent extra oral swelling over left maxilla and numbness of left side of upper lip. Patient had visited general physician with facial cellulitis 6 months ago and was diagnosed with uncontrolled type II diabetes mellitus
References
[1]
S. Viterbo, M. Fasolis, P. Garzino-Demo et al., “Management and outcomes of three cases of rhinocerebral mucormycosis,” Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and Endodontology, vol. 112, no. 6, pp. e69–e74, 2011.
[2]
C. Jagdish, S. Reetika, S. Pallavi, S. Jayanthi, P. Divya, and A. Balasubramanya, “Mucormycosis of the paranasal sinus with gas forming maxillary osteomyelitis—a case report,” The Internet Journal of Microbiology, vol. 10, no. 1, 2012.
[3]
A. A. Bakathir, “Mucormycosis of the jaw after dental extractions: two case reports,” Sultan Qaboos University Medical Sciences Journal, vol. 6, pp. 77–82, 2006.
[4]
E. Bouza, P. Mu？oz, and J. Guinea, “Mucormycosis: an emerging disease?” Clinical Microbiology and Infection, vol. 12, no. 7, pp. 7–23, 2006.
[5]
A. Chakrabarti, A. Das, A. Sharma et al., “Ten years' experience in zygomycosis at a tertiary care centre in India,” Journal of Infection, vol. 42, no. 4, pp. 261–266, 2001.
[6]
M. S. Greenberg, “Ulcerative vesicular and bullous lesions,” in Burket’s Oral Medicine Diagnosis and Treatment, M. S. Greenberg and M. Glick, Eds., p. 79, Elsevier, 2003.
[7]
O. E. Brown and R. Finn, “Mucormycosis of the mandible,” Journal of Oral and Maxillofacial Surgery, vol. 44, no. 2, pp. 132–136, 1986.
[8]
A. Pandey, V. Bansal, A. K. Asthana, V. Trivedi, M. Madan, and A. Das, “Maxillary osteomyelitis by mucormycosis: report of four cases,” International Journal of Infectious Diseases, vol. 15, no. 1, pp. e66–e69, 2011.
[9]
B. Spellberg, J. Edwards Jr., and A. Ibrahim, “Novel perspectives on mucormycosis: pathophysiology, presentation, and management,” Clinical Microbiology Reviews, vol. 18, no. 3, pp. 556–569, 2005.
[10]
C. Fogarty, F. Regennitter, and C. F. Viozzi, “Invasive fungal infection of the Maxilla following dental extractions in a patient with chronic obstructive pulmonary disease,” Journal of the Canadian Dental Association, vol. 72, no. 2, pp. 149–152, 2006.
[11]
V. M. Rao and K. I. El-Noveam, “Sinonasal imaging: anatomy and pathology,” Radiologic Clinics of North America, vol. 36, pp. 921–939, 1998.
[12]
A. K. Gupta, S. B. S. Mann, V. K. Khosla, K. V. Sastry, and J. S. Hundal, “Non-randomized comparison of surgical modalities for paranasal sinus mycoses with intracranial extension,” Mycoses, vol. 42, no. 4, pp. 225–230, 1999.
[13]
L. R. Eversole, Eversole Clinical Outline of Oral Pathology Diagnosis and Treatment, BC Decker Inc., 3rd edition, 2002.
[14]
S. Goel, S. Palaskar, V. P. Shetty, and A. Bhushan, “Rhinomaxillary mucormycosis with cerebral extension,” Journal of Oral and Maxillofacial Pathology, vol. 13, pp. 14–17, 2009.
