Tasty Morsels of EM 042 – MucorMycosis

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