Invasive Rhino-orbito-cerebral Mucormycosis with Hard Palate Involvement

鼻腔白黴病為一種少見且致命性的感染，通常發生在免疫力低下的病患上。侵襲型鼻腦白黴菌鼻竇炎臨床表現呈現疲倦、眼窩後的頭痛、發燒、及偶見的鼻腔出血或分泌物，若感染嚴重則可能侵犯眼睛及中樞神經。本病例報告提出一57歲女性病患因左側視力減退及面部紅腫求診，且併有嚴重的糖尿病。然而理學檢查發現上顎處有壞死，且鼻腔內可見典型的鼻腔焦痂及破壞，影像檢查可見有眼框及顱底、海綿竇的侵犯，手術後病理證實為侵襲性黴菌性鼻竇炎。由於此病早期的治療的介入時間相當重要，此例呈現以硬顎壞死之臨床表現而使得臨床醫師懷疑其可能為鼻腔內之感染所引發，進而實行相關檢查。因此若實施理學檢查時有硬顎壞死的表現，應將侵襲性黴菌鼻竇炎列入鑑別診斷進而及早治療。

關鍵字

白黴病；侵襲性黴菌性鼻竇炎；鼻竇眼眶大腦白黴菌病

並列摘要

Rhino-orbito-cerebral mucormycosis is a rare and life-threatening fungal infection that usually happens under the setting of immunocompromised status. Patients who develop rhino-orbito-cerebral mucormycosis typically present with malaise, retro-orbital headache, fever, and occasionally dark, blood-tinged rhinorrhea. In progressive disease, it may eventually invade the orbit and brain. We here report a 57-year-old female patient with history of poorly controlled diabetes mellitus. She presented with facial swelling, vision loss and non-specific nasal symptoms initially. However, physical examination of the head and neck revealed a huge ulcer over the hard palate and diffuse nasal mucosal necrosis with destruction of the nasal structures. Image study demonstrated devastating disease causing orbital apex syndrome and cavernous sinus involvement. Rhinoorbito-cerebral mucormycosis was proved histopathologically. Because the timing of intervention is essential to the outcome of treatment, we demonstrate the unusual initial local findings of the hard palate that may reflect the underlying severe, destructing fungal sinusitis. When inspecting an abnormal local finding of the hard palate, one may consider invasive fungal sinusitis a differential diagnosis that requires emergent treatment.

並列關鍵字

mucormycosis ； invasive fungal sinusitis ； rhino-orbito-cerebral mucormycosis

國際替代計量

Invasive Rhino-orbito-cerebral Mucormycosis with Hard Palate Involvement

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