Rhinocerebral Mucormycosis in IDDM: Sequential magnetic resonance imaging of long-term survival with intensive therapy
- George W Moll Jr, MD, PHD,
- Frank A Raila, MD,
- Gilbert C Liu, BA and
- A Wallace Conerly Sr, MD
- Departments of Pediatrics, The University of Mississippi Medical Center Jackson, Mississippi
- Departments of Radiology, The University of Mississippi Medical Center Jackson, Mississippi
- The Medical School, The University of Mississippi Medical Center Jackson, Mississippi
- Departments of Medicine, The University of Mississippi Medical Center Jackson, Mississippi
- Departments of Respiratory Therapy, The University of Mississippi Medical Center Jackson, Mississippi
- Division of Pediatric Endocrinology, The University of Mississippi Medical Center Jackson, Mississippi
- Address correspondence and reprint requests to George W. Moll, Jr., MD, PhD, The University of Mississippi Medical Center, 2500 North State St., Jackson, MS 39216-4505.
Abstract
OBJECTIVE To describe the clinical course and the utility of computerized tomography (CT) and magnetic resonance imaging (MRI) in the successful management of an often fatal fungal infection in a 12-year-old patient with insulin-dependent diabetes mellitus (IDDM).
CASE The patient was admitted to The University of Mississippi Medical Center (UMC) for the purpose of diabetic ketoacidosis (DKA) management and subsequent intensive therapy for mucormycosis according to nationally accepted standards of care. Strict diabetic control was instituted with frequent monitoring of blood glucose levels and interval assessment of HbA1c. Sequential MRI studies were obtained according to approved patient standards; the clinical and MRI course of the infection was charted.
RESULTS The patient's DKA resolved within 12 h on intravenous fluid repletion and insulin therapy. His sinusitis/rhinitis noted on admission did not respond to intravenous antibiotic therapy and progressed with obvious left orbital involvement and left cranial nerve palsies by 72 h of hospitalization. CT and MRI were invaluable aids to the early diagnosis and design of appropriate surgical and antifungal management of this patient, who survived with minimal left cranial nerve palsies.
CONCLUSIONS Our patient is among the youngest of IDDM patients reported to have survived rhinocerebral mucormycosis. His survival is attributed to early recognition of possible mucormycosis with diagnostic support of CT and MRI, surgical debridement and antifungal therapy, and intensive blood glucose control. Sequential MRI is invaluable to the design of therapy for this type of patient and shows the nearly 3-year recovery from mucormycosis.
- Received February 24, 1994.
- Revision received May 26, 1994.
- Accepted May 26, 1994.
- Copyright © 1994 by the American Diabetes Association
