Arch Hellen Med, 16(5), September-October 1999, 496–500
Late surgical intervention in
a diabetic patient
with mucormycosis of the head and neck,
after prolonged treatment with liposomal amphotericin B
N. PAPADOGEORGAKIS,1 J. LOGOTHETIS,1
D. RONTOYANNI,2 A. FOUNTAS,3 G. HALEVELAKIS,3 S.A. RAPTIS3
1Department of Head and Nerk Surgery,
2Laboratory of Pathology,
32nd Propedeutic Department of Internal Medicine, Medical School, University of Athens, “Evangelismos” Hospital, Athens, Greece
Mucormycosis is the most dangerous life-threatening fungal infection. It is an opportunistic infection caused by fungi of the family Mucoraceae of the class Zygomycetes. Diabetic, immuno-compromised and trauma patients are at risk of developing mucormycosis. A rhino-orbital primary site, with cerebral spread is the commonest clinical form of the disease, and spread occurs via blood vessels resulting in thrombosis, tissue infarction and necrosis. Biopsy of the involved tissue establishes the diagnosis. Prognosis has improved during recent years but still remains poor. Treatment involves control of the underlying disease, surgical debridement of the dead tissues and systemic anti-fungal therapy. A case is reported of a diabetic patient with mucormycosis of the right orbit and dissemination to the zygomatic and neck area ipsilaterally. Treatment consisted of a combination of systemic antifungal therapy with liposomal amphotericin B, supportive therapy and late surgical intervention. Surgery, which was undertaken following one year of conservative treatment, involved exenteration of the right orbital contents and aggressive debridement of the zygomatic and neck area. Now, four years after the treatment there is not any sign of recurrence.
Key words: Fungal infections, Liposomal amphotericin-B, Mucormycosis.