FUNGAL OSTEOMYELITIS OF ZYGOMATICO-MAXILLARY COMPLEX: A CASE REPORT HIGHLIGHTING CLINICO-PATHOLOGICAL APPROACH TO DIABETIC PATIENTS

Ghulam Saqulain, Muhammad Mumtaz Khan, Sabeen Nasir, Sardar Muhammad, Muhammad Haris Ramzan

Abstract


Osteomyelitis of zygomatico-maxillary complex is rare. We present a diabetic patient who initially reported a small cystic swelling on lower orbital margin which on exploration came out to be a subperiosteal cold abscess. No bone erosion could be detected on routine x-rays. The cytology and initial biopsy revealed chronic nonspecific inflammation. Repeated bacterial cultures and staining for AFB were negative. Later a discharging sinus was formed. CT scan suggested osteomyelitis. Conservative surgery with sequestrectomy and debridement was performed. The biopsy revealed necrotic bony fragments along with fungal hyphae and spores. On fungal culture a growth of Aspergillus flavus was obtained. A final diagnosis of fungal osteomyelitis of lateral part of lower orbital margin involving zygomatico-maxillary complex was made. Patient responded to conservative treatment with oral antifungal agents and minimal surgical intervention. The possibility of fungal etiology must be considered in a diabetic patient even at unusual sites.

Keywords


Aspergillus; Diabetes complications; Osteomyelitis.

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References


Marx RE, Baltensperger M, Eyrich GK. Osteomyelitis of the Jaws. Edited by Berlin Springer-Verlag, 2008. p. 6.

Silverman FN. Virus diseases of bone: do they exist? The Neuhauser Lecture. Am J Roentgenol 1976; 126:677-703.

Rosenberg AE. Bones, Joints, and Soft-Tissue Tumors. Edited by Kumar V, Abbas AK, Fausto N, Aster JC. Philadelphia, Saunders Elsevier, 2010, p. 1290.

Prasad KC, Prasad SC, Mouli N, Agarwal S. Osteomyelitis in the head and neck. Acta Oto-Laryngologica 2007; 127:194-205.

Hovi L, Saarinen U, Donner U, Lindqvist C. Opportunistic osteomyelitis in the jaws of children on immunosuppressive chemotherapy, J Pediatric Hematol Oncol 1996; 18:90-4.

Hudson J. Osteomyelitis of the jaws: a 50- year perspective. J Oral Maxillofac Surg 1993; 51:1294-1301.

Elangovan S, Srinivasa V. Osteomyelitis of multiple cranial bones – a rare presentation, J Evol Med Dental Sci 2013; 2:8314-6.

Bala S, Narwal A, Gupta V, Duhan J, Goel P. Actinomycotic osteomyelitis of mandible masquerading periapical pathology. J Oral Health Comm Dent 2011; 597-9.

Segal E, Eylan E, Romano A, Stein R. Isolation of candida tropicalis from an orbital infection as a complication of maxillary osteomyelitis. Infection 1974; 2:111-2.

Fogarty C, Regennitte F, Viozzi CF. Invasive fungal infection of the maxilla following dental extractions in a patient with chronic obstructive pulmonary disease. J Can Dent Assoc 2006; 72:149-52.

Karjodkar F, Saxena VS, Maideo A, Sontakke S. Osteomyelitis affecting mandible in tuberculosis patients. J Clin Exp Dent 2012; 4:72-6.

Proia L. Efficacy of posaconazole for chronic refractory alternaria infection. Edited by Copenhagen /Denmark, European Society of Clinical Microbiology and Infectious Diseases 2005.

Bradoo RA, Shah KD, Gayathri H, Kapadia MA. Invasive aspergillosis of the temporal bone. Indian J Otol 2012; 18:30-3.

Anita P, Vishal B, K. AA, Vikas T, Molly M, Anupam D: Maxillary osteomyelitis by mucormycosis: report of four cases, International J Infect Dis 2011; 15:66-9.

Lipsett PA. Surgical critical care: Fungal infections in surgical patients, Crit Care Med 2006; 34:S215-24.

Kameswaran M, Raghundhan S. Saprophytic mycotic infections of the nose and paranasal sinuses. Otorhinolaryngol Clin 2009, 1:25-31.

Nayak S, Acharjya B. Mantoux test and its interpretation, Ind Dermatol Online J 2012, 3:2-6.

Chin-Hong PV. Infections in patients with diabetes mellitus: importance of early recognition, treatment and prevention. Adv Stud Med 2006; 6:71-81.


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