İki olgu nedeniyle mukormikozis

Mukormikozis nadir görülen, invaziv ve fulminan seyirli saprofitik bir fungal enfeksiyondur. Bazı tipik klinik bulguları vardır ve genellikle diyabetli immun sistem bozukluğu olan veya immunosupresif tedavi alan hastalarda enfeksiyona yol açmaktadır. Bu çalışmada kliniğimizde takip edilen iki mukormikoz olgusunu sunduk. İlk olgu, 2 yaşında diyabetik ketoasidozlu kız çocuğuydu. Her iki nazal vestibül, nazal septum ve bunlara komşu nazal dorsumda nekroz ve hiperemi mevcuttu. İkinci olgu ise diyabetik ketoasidozu bulunan 17 yaşında bayan hasta idi. Auriküla ve dış kulak yolunda nekroz, aynı tarafta komplet fasiyal sinir paralizi mevcuttu. Her iki hastada histopatolojik ve mikrobiyolojik değerlendirme için doku örneği alındıktan sonra sistemik Amfoterisin B tedavisi başlandı. İkinci hastada nekrotik dokular debride edildi. İlk hasta tedavinin başlangıcından iki gün sonra, ikinci hasta ise tedaviden sonraki yedinci gün kaybedildi. Nadir görülen bu saprofitik enfeksiyonların bakteriyolojik ve histolojik özellikleri ile birlikte tedavi alternatifleri tartışıldı.

Anahtar Kelimeler:

Mukormikozis, Tedavi başarısızlığı, Kulak kepçesi, Burun, Ergen, Ölümle sonuçlanma, Diabetik ketoasidoz, Süt çocuğu, Kadın

Mucormycosis: 2 case report

Mucormycosis is a rare, saprophytic, invasive and fulminant fungal disease. It is infective to patients with underlying immunocompromised conditions. We presented two cases of mucormycosis, one of which occured in the nose and the other on the auricle. A two-year-old female patient with diabetic ketoacidosis revealed necrosis and surrounding hyperemia in the nasal vestibule, nasal septum and dorsum of nose. A 17-year-old female diabetic patient had been suffering from black-colored lesion on the auricle. Physical examination presented necrosis on the auricle. Facial paralysis occured in the patient with auricular mucormycosis. Systemic amphotericin B was empirically administered after the sample was obtained for microbiologic and histopathologic examination in both patients. Necrotic tissues was also debrided in the second patient. The first patient died on the second day of treatment, and the second patient on the seventh day. We discussed the bacteriologic characteristics, histological peculiarities, and alternative treatments.

Keywords:

Mucormycosis, Treatment Failure, Ear Auricle, Nose, Adolescent, Fatal Outcome, Diabetic Ketoacidosis, Infant, Female,

PDF

___

1. Mizutari K, Nishimoto K, Ono T. Cutaneous mucormycosis. J Dermatol 1999;26: 174-177.
2. Ferguson BJ. Mucormycosis of the nose and paranasal sinuses. Otolaryngol Clin North Am. 2000;33:349-365.
3. Yun MW, Lui C, Chen WJ. Facial paralysis secondary to tympanic mucormycosis: case report. Am J Otol 1994;15:413-414.
4. Maniglia AJ, Mintz DH, Novak S. Cephalic phycomycosis. A report of eight cases. Laryngoscope 1982; 92: 755-760.
5. Saydam L, Erpek G, Kızılay A. Calcified Mucor fungus ball of sphenoid sinüs: an unusual presentation of sinoorbital mucormycosis. Ann Otol Rhinol Laryngol.1997; 106: 875-877.
6. Yehia MM, Al-habib HM, Sheehab NM. Otomycosis: A common problem in North Iraq. J Laryngol Otol 1990;104:387-389.
7. Harris JJ. Mucormycosis: Report of a case. Pediatrics 1955;16:857-867
8. Espinoza CG, Halkias DG. Pulmonary mucormycosis as a complication of chronic salicylate poisoning. Am J Clin Pathol 1983;80:508-511
9. Chinn RYW, Diamond RD. Generation of chemotactic factors by Rhizopus oryzae in the presence and absence of serum: Relationship to hyphal damage mediated by human neutrophils and effects of hyperglycemia and ketoacidosis. Infect Immun 1982;38:1123-1129.
10. Ketenci I, Unlu Y, Senturk M, Tuncer E. Indolent mucormycosis of the sphenoid sinüs. Otolaryngol Head Neck Surgery. 2005;132: 341-342.
11. Barron MA, Lay M, Madinger NE. Surgery and treatment with high-dose liposomal amphotericin B for eradication of craniofacial zygomycosis in a patient with Hodgkin's disease who had undergone allogeneic hematopoietic stem cell transplantation. J Clin Microbiol. 2005;43:2012-2014.