Invasive cranial mycosis our experiences
A 56yr old male[], recently detected to have diabetes was admitted in our institute in Hyperglycaemic Hyperosmolar State (serum osmolarity - 347meq/dl) with septicaemia and renal insufficiency. He was treated with intravenous insulin infusion and injectable antibiotics. Within 48 hrs, he became well hydrated and his sensorium improved. His sugars were well controlled. After 3 days, he complained of pain in right eye and right maxillary region. He also developed ptosis [] with complete ophthalmoplegia with dilated fixed pupil on the right side. CT scan head & orbit showed granulomas at right orbital apex. Some destruction of contiguous bone was also reported. He then developed black necrotic area adjacent to nose on right side and there was necrotic mass in right nasal cavity. Patient was taken for emergency surgery and debridement of necrotic mass was done. Mass showed broad, non-septated, ribbon like hyphae with wide angled branching on fresh KOH mount []. Culture later grew mucormycosis. Inj. amphotericin B was started.\nFinal impression was Hyperglycaemic Hyperosmolar State with Mucormycosis. Despite good control of sugars, adequate debridement and antifungal therapy, patient succumbed.