Rhinocerebral mucormycosis in a diabetic patient with cranial nerve involvement

Abstract

We report a case of 50- year-old diabetic edentulous woman (FBS=396mg/dl) with chief complain of left side facial pain treated by her physician with corticoid and antibiotic for 15 days without any improvement. With pain exacerbation and skin paresthesia she was referred to oral medicine department of Mashhad school of dentistry by a neurologist with diagnosis of dental infection. On examination, she had left side facial palsy, ptosis, and a mass which was anterior to her left ear. Left eye had loss of vision and was fixed. Due to involvement of II, III, IV, V, VI, VII cranial nerves, maxillary sinus, orbit and base of the skull we referred her to neurosurgery department with clinical diagnosis of mucormycosis. Left maxillectomy along with enucleation of left eye was carried out. Histopathology confirmed the diagnosis. Patient was put on amphotericin B under medical care in hospital.  Follow up showed the patient is responding and in good health. Early diagnosis and prompt treatment can reduce the mortality and morbidity of this lethal fungal infection.