Invasive fungal rhino sinusitis and Diabetes
Whenever as a doctor you get a patient with some serious illness which is difficult to manage, a sense of gloominess prevails. Patients of uncontrolled diabetes do get some life threatening infections and to treat them becomes a challenge. Invasive fungal rhino sinusitis is one such dreaded infection which until recently was having almost fatal outcome and even if saved were left with serious morbidities like lost vision, lost orbit. The only effective anti fungal amphotericine is highly toxic and its liposomal variant is expensive.
Last month managed one such pt, a 50 yr old lady with uncontrolled diabetes , blood sugar levels touching 350 mg/dl admitted in the hospital with severe headache, diplopia due to ophthalmoplegia of rt eye. Diagnostic nasal endoscopy revealed pale darkening mucosa , took smear and tissue for biopsy. CT and MRI revealed opacities in adjoining ethmoid and frontal sinuses.
All the picture was suggestive of invasive fungal disease[ mucormycosis ]and smear was positive for fungus. A team of Physician, Diabetologist, Ophthalmologist, Plastic surgeon, Nephrologist and myself ENT surgeon were involved in the management of this patient.
Medications to control sugar were started along with liposomal amphotericine and endoscopic transnasal exenteration of sinonasal cavity was planned and done. Thorough clearance of diseased tissue, bone was done from the adjoining frontal, ethmoidal and sphenoid sinuses, however bony framework was kept intact.
Four weeks course of amphotericine was given and fortunately she tolerated the medicine well. Her movements of eyeball improved, diplopia disappeared. She is now on oral posaconazole, planned to be given for two months.
Check endoscopy six weeks after surgery revealed healthy well healed sinus cavity. This is one of the few cases that we were able to save without any morbidity, her vision remained good and with controlled sugar she is looking absolutely healthy.
This is purely a team work !
Last month managed one such pt, a 50 yr old lady with uncontrolled diabetes , blood sugar levels touching 350 mg/dl admitted in the hospital with severe headache, diplopia due to ophthalmoplegia of rt eye. Diagnostic nasal endoscopy revealed pale darkening mucosa , took smear and tissue for biopsy. CT and MRI revealed opacities in adjoining ethmoid and frontal sinuses.
All the picture was suggestive of invasive fungal disease[ mucormycosis ]and smear was positive for fungus. A team of Physician, Diabetologist, Ophthalmologist, Plastic surgeon, Nephrologist and myself ENT surgeon were involved in the management of this patient.
Medications to control sugar were started along with liposomal amphotericine and endoscopic transnasal exenteration of sinonasal cavity was planned and done. Thorough clearance of diseased tissue, bone was done from the adjoining frontal, ethmoidal and sphenoid sinuses, however bony framework was kept intact.
Four weeks course of amphotericine was given and fortunately she tolerated the medicine well. Her movements of eyeball improved, diplopia disappeared. She is now on oral posaconazole, planned to be given for two months.
Check endoscopy six weeks after surgery revealed healthy well healed sinus cavity. This is one of the few cases that we were able to save without any morbidity, her vision remained good and with controlled sugar she is looking absolutely healthy.
This is purely a team work !
Comments
Post a Comment