RHINO-SINO-ORBITAL MUCORMYCOSIS IN A RENAL TRANSPLANT PATIENT

A 53-year old woman with a history of renal transplantation was admitted to the hospital because of headache, blurring of vision and fever six years ago. She had a history of post transplant diabetes mellitus since 5 years ago that was controlled with insulin. Physical examination on admission was a low grade fever, periorbital edema, erythema, chemosis, and tenderness of maxillary bone. The tissue was obtained by sublabial Caldwell incision that contained sinus mucosa and skin granulation tissue and was sent to pathology. The pathologic review of specimens disclosed invasion by nonseptate hyphae fungi that was compatible with invasive mucormycosis. Regardless of surgical deridement and continued amphotericin B with doses more than 1mg/kg for more than 5 weeks, the disease progressed. Mucormycosis in immunosuppressed and especially diabetic patients must be considered and has a high mortality rate. Success in treatment and survival improvement may be achieved by early and extensive surgical excisions in addition to prolonged antifungal drug administration