Spotter of the week

06 DEC 2014

What Renuka Says Spotter Series ...

Dr Digvijy, DNB Y-I

42 years old male patient k/c/o Diabetes melitus not on treatment
Admitted in local hospital at Oman on 15/11/ 2014 for URTI with Bleeding and purulent discharge from nose
In evening he developed drooping of left eyelid with proptosis  and swelling
Deviation of angle of mouth to rt. Side With drooling of saliva from lt side of angle of mouth
Also complained difficulty in swallowing and nasal regurgitation
Discharged from there after 3 days as per his request

Nervous examination
3,4,6th-Lt.ptosis+,movements are restricted on lt. Side in all directions
5th-Decreased sensations on face, corneal reflex lt. side- absent
7th-Unable to raise his eyebrows on lt. Side, blowing of his mouth absent,deviation of angle of mouth on rt. Side
9,10-deviation of soft palate on rt. Side, dysphagia +

Invasive sinusitis with left orbital cellulitis and extension along the skull base and neck space with left cavernous sinus thrombosis.

Multiple cranial nerve palsies secondary to invasive mucormycosis
(Fungal smear of nasal swab-Fungal Hyphae noted suggestive of mucormycosis)

Treatment -
Inj Phosome 200mg IV OD
Tab.Deferasirox 500mg  BD
Underwent surgical debridement of involved sinus tissues.

RISK factors -
Diabetes mellitus, particularly with ketoacidosis
Treatment with glucocorticoids
Hematologic malignancies
Hematopoietic stem cell transplantation
Solid organ transplantation
Iron overload