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