Rhinocerebral Mucormycosis Associated With Anterior Skull Base Actinomyces Osteomyelitis in a Pediatric Patient With Type 1 Diabetes

Abstract

Rhino-orbital-cerebral mucormycosis (ROCM) is a fulminant, often fatal, angioinvasive fungal infection commonly transmitted through inhalation of fungal spores and traumatic inoculation. While the literature has documented rare cases of infection in immunocompetent patients, the vast majority of case fatalities are noted in immunosuppressed populations. Common predisposing factors to infection include immunosuppressive therapies, hematologic malignancies, and most notably, uncontrolled diabetes. Actinomycosis is a subacute to chronic bacterial infection stemming from non-spore-forming anaerobic/microaerophilic bacteria of the genus Actinomyces. Infection with Actinomyces species has been documented across numerous anatomical sites; however, literature on concurrent infection with ROCM in pediatric patients is sparse. We document a case of a 17-year-old male with uncontrolled type 1 diabetes who presented to the emergency department with combined ROCM and actinomycotic infection of his anterior skull base.

Keywords: actinomycetes; diabetes mellitus type i; functional endoscopic sinus surgery; pediatric infectious disease; rhinocerebral mucormycosis.

Figure 1. Preoperative CT and MRI images obtained after initial presentation.

(A) Coronal CT showing dehiscence of the cribriform plate and opacification of left posterior ethmoid cells; (B) T1 axial MRI showing subperiosteal abscess in right medial orbit; and (C) T1 axial MRI showing bilateral frontal lobe abscesses.