A 52-year-old male diabetic presents with a week-long history of fever, headache, confusion, facial nerve palsy with pain and a black, purulent nasal discharge. He is referred to ICU for his deteriorating level of consciousness.

Give the most likely diagnosis.   (20% marks)

List four predisposing factors.    (10% marks)

List the specific management of this condition.         (40% marks)

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College Answer

a)

  • Rhinocerebral mucormycosis or fungal sinus infection with cerebral spread.

b)                                                                   

  • HIV/AIDs Diabetes
  • Cancer – lymphoma
  • Renal failure
  • Organ transplantation
  • Long term steroid or immunosuppressive therapy
  • Cirrhosis
  • Deferoxamine therapy
  • Iron overload
  • Burns

c)

  • Investigation with MRI or CT to determine the extent of the spread. 
  • Blood culture and biopsy to obtain tissue for fungal culture +/- Surgical debridement if amenable
  • Amphotericin B
  • Possibly hyperbaric oxygen therapy.

 

Discussion

 

References

References

Clermont, Gilles, et al. "Renal failure in the ICU: comparison of the impact of acute renal failure and end-stage renal disease on ICU outcomes." Kidney international 62.3 (2002): 986-996.

Szamosfalvi, Balazs, and Jerry Yee. "Considerations in the critically ill ESRD patient." Advances in chronic kidney disease 20.1 (2013): 102-109.

Arulkumaran, N., N. M. P. Annear, and M. Singer. "Patients with end-stage renal disease admitted to the intensive care unit: systematic review." British journal of anaesthesia 110.1 (2013): 13-20.

Thompson, Stephanie, and Neesh Pannu. "Renal replacement therapy in the end-stage renal disease patient with critical illness." Blood purification 34.2 (2012): 132-137.