Rhino-orbital-cerebral mucormycosis in type 1 diabetes mellitus

AIM : To describe the presentation and outcome of rhino-orbital-cerebral mucormycosis (ROCM) in adolescents with type 1 diabetes mellitus (T1 DM).Methods : the medical records of six patients of T1 DM with ROCM admitted between October 2001 to January 2004 were analysed.Results : the mean (± SD) age and duration of DM of these patients were 16.1 ±3.0 years and 26.3 ± 24.9 months respectively. Four patients had ROCM at presentation, while two developed it during their hospital stay when recovering from diabetic ketoacidosis. Proptosis (100%) and ptosis (100%) were the most common symptoms, and ophthalmoplegia (85%) and vision loss (85%) were the most common signs. Maxillary sinus (85%) was the commonest paranasal sinus to be involved. All patients received amphotericin B and had appropriate surgery except one. Four patients survived. Patients who had altered sensorium, facial necrosis, palatal perforation and cerebral involvement at presentation had poor outcome.Conclusion : High index of suspicion of ROCM in T1 DM and combined approach with amphotericin B and appropriate surgery is rewarding.