Multipl kranial nöropatiyle prezente olan rinoserebral mukormikoz olgusu
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Date
2019-09-02
Authors
Şimşek, Fatma
Kızıldağ, Nazım
Karaman, Hasan
Aktaş, Yunus Emre
Journal Title
Journal ISSN
Volume Title
Publisher
Bursa Uludağ Üniversitesi
Abstract
Rinoserebral mukormikoz, mukormikozun en sık görülen formu olup, fatal seyreden fulminan bir enfeksiyondur. Sıklıkla immunsüprese ve diabeti olup ketoasidoz gelişen hastalarda görülmektedir. Hastalık primer olarak paranazal sinüslerde olup direk yolla yada damar duvarı invazyonu ile intrakranial yayılım gösterir. Rinoserebral mukormikoz, ateş, pürülan burun akıntısı, baş ağrısı, yüz ağrısı gibi akut sinüzit bulguları ile gelebilir. Mortal seyirli bir hastalık olduğu için diabet tanılı, ketoasidozu olan ve akut sinüzit bulguları gelişen hastalarda mukormikoz tanısının dışlanması önemlidir. Tedavisi zor bir hastalıktır. Tanı ne kadar erken konulup tedaviye ne kadar erken başlanırsa başarı şansı o kadar yükselmektedir. Nekrotik dokunun debritmanı ve yüksek doz amfoterisin B kullanımı tedavinin ana prensibini oluşturmaktadır. Burada multipl kranial nöropatisi gelişerek takipte mukormikoz tanısı alan ve ilk görüntülemelerinde hafif akut sinüzit bulguları olan hasta sunulmuştur. Bu vakada diabetik ketosidozu ve akut sinüziti olan hastalarda mukormikozun ayırıcı tanıda ilk ekarte edilmesi gereken hastalık olması gerektiği vurgulanmak istenmiştir.
Rhinocerebral mucormycosis is the most common form of mucormycosis and is a fatal fulminant infection. It is frequently seen in patients with immunosuppression and diabetes who develop ketoacidosis. The disease is primarily located in the paranasal sinuses and shows intracranial spread by direct or vessel wall invasion. Rhinocerebral mucormycosis may present with signs of acute sinusitis such as fever, purulent nasal discharge, headache, and facial pain. It is important to exclude the diagnosis of mucormycosis that is a mortal disease in patients with diabetes, ketoacidosis and acute sinusitis. It is a difficult disease to treat. The earlier the diagnosis is made and the sooner the treatment is started, the higher the chance of success. Debridement of necrotic tissue and the use of high-dose amphotericin B are the main principles of treatment. We present a patient with multiple cranial neuropathies who was diagnosed as mucormycosis at follow-up and had mild acute sinusitis on initial imaging. In this case, it is emphasized that mucormycosis should be the first disease to be ruled out in the differential diagnosis in patients with diabetic ketoacidosis and acute sinusitis.
Rhinocerebral mucormycosis is the most common form of mucormycosis and is a fatal fulminant infection. It is frequently seen in patients with immunosuppression and diabetes who develop ketoacidosis. The disease is primarily located in the paranasal sinuses and shows intracranial spread by direct or vessel wall invasion. Rhinocerebral mucormycosis may present with signs of acute sinusitis such as fever, purulent nasal discharge, headache, and facial pain. It is important to exclude the diagnosis of mucormycosis that is a mortal disease in patients with diabetes, ketoacidosis and acute sinusitis. It is a difficult disease to treat. The earlier the diagnosis is made and the sooner the treatment is started, the higher the chance of success. Debridement of necrotic tissue and the use of high-dose amphotericin B are the main principles of treatment. We present a patient with multiple cranial neuropathies who was diagnosed as mucormycosis at follow-up and had mild acute sinusitis on initial imaging. In this case, it is emphasized that mucormycosis should be the first disease to be ruled out in the differential diagnosis in patients with diabetic ketoacidosis and acute sinusitis.
Description
Keywords
Rinoserebral mukormikoz, Diabetes mellitus, Kranial nöropati, Akut sinüzit, Rhinocerebral mucormycosis, Cranial neuropathy, Acute sinusitis
Citation
Şimşek, F. vd. (2019). "Multipl kranial nöropatiyle prezente olan rinoserebral mukormikoz olgusu". Uludağ Üniversitesi Tıp Fakültesi Dergisi, 45(3), 323-326.