Tasty Morsels of EM 042 – MucorMycosis

3 Dec

As always, this is from the ever expanding google doc on bits and bobs I read and learn from and transfer here for all our learning pleasure.

This time it’s the somewhat obscure MucorMycosis.

This is of course from the just released Dec 2014 EMRAP [paid access but worth it] and I’m sure lots of you have heard it. This is going to be really rare and you may never see it, but it’s definitely a diagnosis you cannot afford to miss.

  • Invasive fungal infection can be disseminated but typically rhinosinusitis
  • being immunocompromised and DM (esp with ketosis) are the key risk factors
  • we all get exposed to the same fungi all the time and in immune competency its never a problem
  • it’s called “angioinvasive” meaning that you will see infarction and necrosis as vascular supply is interrupted
  • bizarrely the desferroxamine you use to treat iron poisoning increases your risk for this
  • presentation
    •  initially just think sinusitis, pain, fever, discharge
    • when they’re really sick you’ll probably think of orbital cellulitis (proptosis and eye movement or visual problems) and the danger is that you’ll stop looking – you’ll see a sick patient with probably orbital cellulitis and give antibiotics and refer
    • the key feature that gets mentioned is palatal eschars or eschars in the nasal cavity so the take home message is LOOK IN THE FREAKING MOUTH PEOPLE
  • there are great images on google images though they are pretty disturbing
  • as for treatment think of this the same way you think of necrotising fascitis
    • the most important thing is mobilising the surgeons (likely ENT)
    • Give Amphotericin B but they need debridement

References:

  • Dec 2014 EMRAP
  • Nice review paper in Clinical Infectious Diseases [FOAMed pdf, and it has pictures]
  • Rosen’s 8th Page 976

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