1/5. Bronchial mucormycosis with progressive air trapping.A previously healthy 70-year-old woman developed fever, cough, and exertional dyspnea. Her symptoms progressed over a 2-month period despite treatment by her primary care physician with 2 courses of oral antibiotics and the addition of prednisone. Hypoxemia and the finding of hyperglycemia with mild ketoacidosis led to hospital admission. Serial chest radiographs demonstrated diffuse heterogeneous pulmonary opacities and progressive air trapping in the right lower lobe. Fiberoptic bronchoscopy revealed a deep penetrating ulcer with exposed bronchial cartilage of the bronchus intermedius and dynamic airway obstruction with complete closure during expiration. biopsy of the ulcer revealed rhizopus arrhizus. Respiratory failure stabilized with the patient on conventional mechanical ventilation and receiving amphotericin b. Before surgery could be performed, pseudomonas aeruginosa pneumonia and septic shock developed, and the patient died.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/5. mucormycosis manifesting as proptosis and unilateral blindness.A 51-year-old woman presented to the emergency department (ED) of another institution with sudden onset of blindness in the left eye. The patient was found to have no light perception in the left eye and a marked chemosis occurring several days after a fall. She was transferred to the hospital for ophthalmologic evaluation. Upon careful history and physical examination, the diagnosis of rhinocerebral mucormycosis was considered and urgent ophthalmology and otolaryngology consults were obtained. The patient underwent extensive surgical debridement and pharmacologic treatment. The diagnosis was confirmed by pathological specimens. In this case report, the clinical presentation, pathogenesis, diagnostic workup, and ED management of mucormycosis are discussed, highlighting the possible diagnostic and therapeutic pitfalls that are most pertinent to the emergency physician.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/5. Rhinocerebral mucormycosis: a report of eleven cases.Rhinocerebral mucormycosis (RCM) is a rare, fulminant fungal infection that usually occurs in diabetic or immunocompromised patients. The mortality rate has been reduced recently with the advent of amphotericin b combined with aggressive surgery. Eleven RCM patients have been treated over the past five years at Srinagarind Hospital. Eight had underlying diabetes, five had renal failure and three of them had both. In eight patients, the diagnosis was established by KOH preparation before histological confirmation. Only two cases revealed positive cultures for rhizopus spp and cunninghamella spp. All patients underwent surgical treatments (extensive debridement, 8 cases; sphenoidectomy, 7 cases; ethmoidectomy 8 cases; maxillectomy 5 cases and orbital exenteration, 6 cases). amphotericin b was administered to all patients as soon as the diagnosis of RCM was made. Only three patients survived. early diagnosis and cooperation among ophthalmologist, otolaryngologist and physician are the most important factors for the survival of patients with mucormycosis.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/5. Rhinocerebral mucormycosis: three case reports and subject review.Rhinocerebral mucormycosis (RCM) in the diabetic patient can be a particularly aggressive and devastating disease. The emergency physician will typically see patients with RCM in its earliest stages masquerading as a variety of other, less serious diseases. early diagnosis is the key to a successful outcome. Three such cases seen in the emergency department are reviewed with attention to their initial clinical presentation and treatment. In addition, the historical, pathophysiologic, clinical, and therapeutic aspects of RCM are reviewed.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/5. Early onset of pulmonary mucormycosis with pulmonary vein thrombosis in a heart transplant recipient.Pulmonary infections are major complications in heart transplantation. Progress in antimicrobial chemotherapy has switched the clinical spectrum to an increased incidence of fungal pathogens, such as candida and aspergillus species. mucormycosis is a rare opportunistic infection with high mortality in solid-organ transplant recipients usually ensuing several months after transplantation. We describe a 45-year-old patient with pulmonary mucormycosis manifestion 5 days after heart transplantation. The infection resulted in pulmonary vein thrombosis followed by hemorrhagic infarction. Despite antifungal treatment and surgical resection, the patient died on day 14 after transplantation. Antemortem diagnostic procedures were negative; autopsy confirmed the presence of rhizopus oryzae invading blood vessels. We conclude that physicians must be aware of mucormycosis even within one week after heart transplantation--which has not been described so far. Invasive diagnostic workup is mandatory in case of suspicion; amphotericin b and, in selected cases, surgical resection are the mainstays of therapy.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |