Photo Rounds

Nasal discharge

A middle-aged man with poorly controlled type 2 diabetes went to see his family physician (FP) because he had a fever, nasal discharge, and facial pain. While examining the patient, the FP noted black discharge in the right nostril. The patient appeared systemically ill. The FP called in his otolaryngology colleague for assistance.

What’s your diagnosis?


 

The FP and the otolaryngologist suspected that the patient had mucormycosis sinusitis.

Mucormycosis is a rare and potentially deadly fungal infection that tends to occur in patients who are immunosuppressed. While it might involve the sinuses, mucormycosis typically involves the brain or lungs. Early diagnosis and treatment are critical to survival. Patients are treated with amphotericin B intravenously in the hospital, with an infectious disease consult to help guide therapy. A consultation with an otorhinolaryngologist should be obtained, as surgery may be needed.

In this case, the diagnosis of mucormycosis was confirmed with a biopsy of the involved tissue. The patient was hospitalized and early antifungal treatment saved his life.

Photo courtesy of Randal A. Otto, MD. Text for Photo Rounds Friday courtesy of Richard P. Usatine, MD. This case was adapted from: Smith M. Sinusitis. In: Usatine R, Smith M, Mayeaux EJ, et al, eds. Color Atlas of Family Medicine. 2nd ed. New York, NY: McGraw-Hill; 2013:197-202.

To learn more about the Color Atlas of Family Medicine, see: http://www.amazon.com/Color-Family-Medicine-Richard-Usatine/dp/0071769641/ref=dp_ob_title_bk

You can now get the second edition of the Color Atlas of Family Medicine as an app for mobile devices by clicking on this link: http://usatinemedia.com/

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