Mucormycosis: A rare entity with rising clinical presentatio
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Mucormycosis is a rare, rapidly progressive and a fulminant, life-threatening, opportunistic infection. Although it most commonly manifests in diabetic patients, its presence in other immunologically compromised patients cannot be ruled out. Its etiology is saprophytic fungal organisms, with rhizopus being the most common causative organism. Clinically the disease is marked by a partial loss of neurological function and a progressive necrosis due to the invasion of the organisms into the blood vessels causing a lack of blood supply. The disease may progress to involve the cranium thereby increasing the mortality rate. The first line of management in mucormycosis is antifungal therapy which may extend and also include surgical management.

A 60 yr old male presented to our institute with a painful non-healing wound, involving the palate for the last four months. He also complained of pus discharge and bad breath along with difficulty in eating, drinking, and swallowing. There was also a complaint of incomplete healing of the sockets of maxillary anterior teeth, post-extraction. He was a known diabetic for 6 years. Intraoral examination revealed unhealed sockets in the maxillary anterior region with exposed necrotic bone. A necrotizing ulcer was also seen involving the alveolar bone of the anterior maxillary region and the entire hard palate. The ulcer was approximately 5 × 5 cm in size and was covered by a yellowish slough. Palpation revealed that the whole of the maxillary arch was mobile. The lymph nodes were not palpable. The clinical picture was suggestive of a deep-seated fungal infection.

Hematological investigations revealed, a high fasting blood sugar level, decreased hemoglobin (8 g%), and HbA1c at 8.7 %. Radiographic examination by means of an Orhtopantomogram(OPG) and Cone-beam computed tomography examination(CBCT) revealed discontinuity in the nasal and maxillary areas with the moth-eaten appearance of bone accompanied with haziness and obliteration of both the maxillary sinuses, Osteolytic lesions were also observed involving the maxillary alveolar bone that was extending from right maxillary second molar to left maxillary first molar region. Perforation of the palate was also evident. Cytological smear and incisional biopsy were taken from alveolar and palatal regions to further confirm the diagnosis.

Based on clinical, radiological, and histopathological findings, the final diagnosis of rhinomaxillary mucormycosis was made. The patient was referred to the physician for the control of diabetes and to improve the hemoglobin. Simultaneously, systemic antifungal therapy (IV Amphotericin B) was administered to him. After the control of diabetes, surgical excision of the maxilla was done along with debridement of the nasal vault. An obturator was given to cover the defect. The histopathology of the excised specimen confirmed our diagnosis of mucormycosis. The patient was closely followed up and the healing was uneventful.