Case Report: Parapharyngeal Mucormycosis Rare Presentation with Literature Review
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CLINICAL REPORT
Case Report: Parapharyngeal Mucormycosis Rare Presentation with Literature Review Kasim S. Kasim Aljanabi1 • Talib Almaqbali1 • Ahmed Asaad Hassan Alkilidar1 Yasser A. Razek Mohamed Salim2
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Received: 7 September 2020 / Accepted: 3 November 2020 Ó Association of Otolaryngologists of India 2020
Abstract Mucormycosis is a rare fungal infection that typically involves the rhino-cerebral area with a high morbidity and mortality. Involvement of the parapharyngeal space and gastrointestinal tract with perforation is rare and may be related to dissemination of the disease. The current antifungal treatment has been shown to be inadequate with variable outcomes and is often instituted late in the disease process with unfortunate outcomes. Keywords Mucormycosis Parapharyngeal space Intestinal mucor
Case History 30 years old gentleman not known to have any medical illness presented to emergency department with severe sore throat mainly on the left side associated with sever odynophagia and high grade fever for 10 days duration not responding to oral medical treatment given from local health center. On examination, he was ill looking, dehydrated and febrile. On oral exam noted to have left peritonsillar bulge with medialized left lateral pharyngeal wall and uvula pushed to the right side. Aspiration from the maximum bulge area was attempted but was negative. He was noted to have high random blood sugar (22 mmol/l) and high HBA1c (hemoglobin A1c) noted to be 14 and severely deranged renal function and treated by
medical team as diabetic ketoacidosis secondary to sepsis as evident by investigations. Contrast enhanced CT scan (Figs. 1, 2) showed: multiloculated abscess areas starting from the nasopharynx and reaching the oro-pharynx measuring 35 9 29 9 52 mm. Left ICA, 16 mm of its origin there was 20 mm in length of significant lumen attenuation with aneurysmal dilatation of the left ICA about 11 9 10 mm at C1 vertebral level. His paranasal sinuses, brain and chest CT were unremarkable. Patient underwent surgical exploration under GA with drainage of the left parapharyngeal space and biopsy was obtained from the same area in which the biopsy came as mucormycosis. His swab culture grew multidrug resistant for acinetobacter baumanni and streptococcus group D. He was treated aggressively with culture directed broad spectrum antibiotics and liposomal amphotericin B with strict DM control by multidisplinary team approach. Ten days post intubation, he was noted to have significant abdominal distention and an urgent consultation to general surgery team was done. After thorough exam and radiological investigation he was suspected to have an ischemic bowel with perforated viscous for which he underwent urgent laparotomy with right hemi-collectomy for cecal perforation. Post operatively he was found to have mucormycosis of the intestinal tract and eventually succumbed to the sequelae of the infection.
Hospital Course & Kasim S. Kasim Aljanabi [email protected] 1
Department of ENT, Sohar Hospital, Sohar, Oman
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