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Case Reports in Medicine
Volume 2014, Article ID 527062, 6 pages
http://dx.doi.org/10.1155/2014/527062
Case Report

Multimodal Surgical and Medical Treatment for Extensive Rhinocerebral Mucormycosis in an Elderly Diabetic Patient: A Case Report and Literature Review

1Department of Sciences for Health Promotion and Mother-Child Care “G. D’Alessandro”, University of Palermo, Via del Vespro 127, 90127 Palermo, Italy
2Plastic and Reconstructive Surgery, Department of Surgical, Oncological and Stomatological Sciences, University of Palermo, Via del Vespro 129, 90127 Palermo, Italy
3Laboratory of Molecular Endocrinology, Section of Endocrinology, Biomedical Department of Internal and Specialized Medicine (Di.Bi.M.I.S), University of Palermo, Via del Vespro 127, 90127 Palermo, Italy
4Section of Radiology, Di.Bi.Me.F., University of Palermo, Via del Vespro 129, 90127 Palermo, Italy
5Section of Radiology, “P. Giaccone” Teaching Hospital Palermo, Via del Vespro 127, 90127 Palermo, Italy

Received 29 January 2014; Revised 4 April 2014; Accepted 4 May 2014; Published 27 May 2014

Academic Editor: Jacques F. Meis

Copyright © 2014 Paola Di Carlo et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Diabetes is a well-known risk factor for invasive mucormycosis with rhinocerebral involvement. Acute necrosis of the maxilla is seldom seen and extensive facial bone involvement is rare in patients with rhino-orbital-cerebral mucormycosis. An aggressive surgical approach combined with antifungal therapy is usually necessary. In this report, we describe the successful, personalized medical and surgical management of extensive periorbital mucormycosis in an elderly diabetic, HIV-negative woman. Mono- or combination therapy with liposomal amphotericin B (L-AmB) and posaconazole (PSO) and withheld debridement is discussed. The role of aesthetic plastic surgery to preserve the patient’s physical appearance is also reported. Any diabetic patient with sinonasal disease, regardless of their degree of metabolic control, is a candidate for prompt evaluation to rule out mucormycosis. Therapeutic and surgical strategies and adjunctive treatments are essential for successful disease management. These interventions may include combination therapy. Finally, a judicious multimodal treatment approach can improve appearance and optimize outcome in elderly patients.