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An Official Publication of the Indian Association of Oral and Maxillofacial Pathologists


 
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Year : 2012  |  Volume : 16  |  Issue : 2  |  Page : 308-309
 

Mucormycosis in an immunocompetent patient


Department of Oral and Maxillofacial Pathology, Tamil Nadu Government Dental College and Hospital, Chennai, India

Date of Web Publication27-Jul-2012

Correspondence Address:
Ramakrishnan Bharathi
Department of Oral and Maxillofacial Pathology, Tamil Nadu Government Dental College and Hospital, Chennai
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0973-029X.99100

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How to cite this article:
Bharathi R, Arya AN. Mucormycosis in an immunocompetent patient. J Oral Maxillofac Pathol 2012;16:308-9

How to cite this URL:
Bharathi R, Arya AN. Mucormycosis in an immunocompetent patient. J Oral Maxillofac Pathol [serial online] 2012 [cited 2019 Dec 16];16:308-9. Available from: http://www.jomfp.in/text.asp?2012/16/2/308/99100


Mucormycosis is a rare opportunistic fungal disease, causing infections of the upper and lower respiratory tract, commonly affecting the paranasal sinuses. [1] The fungi are large, with branching nonseptate hyphae. [2] They disrupt normal blood flow by invading into small blood vessels, resulting in infarction and extensive tissue necrosis. [1] Mucormycosis is usually noted in individuals with diabetic ketoacidosis and also in other conditions like bone marrow transplant patients, patients with AIDS, and those receiving systemic corticosteroid therapy, desferoxamine therapy, and cancer chemotherapy. [3] Mucormycosis has been rarely reported in apparently normal, immunocompetent individuals, [2] like our patient under consideration.

A 37-year-old male patient presented with the complaint of pain and pus discharge from extracted, nonhealing tooth socket in the left upper jaw. The tooth was extracted 1 month earlier for acute irreversible pulpitis.

The patient had a mild diffuse swelling over the left side of the face. Intraorally, blackish discoloration of the alveolar mucosa was noted in relation to maxillary premolar region on the left side. There was pus discharge and foul-smelling odor. He also had no history diabetes mellitus or HIV infection or prolonged corticosteroid therapy or any other medications.

Computerized tomographic imaging with serial and coronal sections of paranasal sinuses established the oroantral communication in the left premolar region, and also haziness was noted in the left maxillary sinus owing to accumulation of pus.

The lesion was explored and the necrotic bony sequestrum and sinus lining were removed and sent for histopathological examination.


   Histopathology Top


  • Necrotic tissue and debris with prominent stout, nonseptate fungal hyphae, some showing branching at acute angles or 90 degrees [Figure 1] and [Figure 2].
  • Figure 1: Shows necrotic debris and prominent stout, nonseptate fungal hyphae, some showing branching. The fungal hyphae are cut in different planes (H and E, 100)

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    Figure 2: Shows branched nonseptate hyphae of mucormycosis (H and E, 400)

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  • Some fungal hyphae appear to be cut transversely along their diameter while sectioning [Figure 2].
  • Presence of inflammatory cells in the necrotic tissue [Figure 3].
  • Figure 3: Shows inflammatory cells interspersed between fungal hyphae and necrotic debris (H and E, 400)

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  • The bony sequestrum showed necrotic lamellar bone surrounded by multiple fungal hyphae [Figure 4] and [Figure 5].
  • Figure 4: Shows fungal hyphae adjacent to necrotic lamellar bone (H and E, 400)

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    Figure 5: Grocott-Gomori methamine staining showing brown– black fungal hyphae in green background ( 100)

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  • Grocott-Gomori methamine silver staining shows prominent fungal hyphae stained brown-black in green background [Figure 5] and [Figure 6].
  • Figure 6: Fungal hyphae adjacent to necrotic bone, confirmed by Grocott-Gomori methamine staining ( 400)

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   Final Diagnosis Top


Based on the above histopathological features, the final diagnosis of mucormycosis was given.

 
   References Top

1.Auluck A. Maxillary necrosis by mucormycosis. a case report and literature review. Med Oral Patol Oral Cir Bucal 2007;12:E360-4.  Back to cited text no. 1
[PUBMED]    
2.Butala A, Shah B, Cho YT, Schmidt MF. Isolated pulmonary mucormycosis in an apparently normal host: a case report. J Natl Med Assoc 1995;87:572- 4.  Back to cited text no. 2
[PUBMED]    
3.Roden MM, Zaoutis TE, Buchanan WL, Knudsen TA, Sarkisova TA, Schaufele RL, et al. Epidemiology and outcome of zygomycosis: a review of 929 reported cases. Clin Infect Dis 2005;41:634-53.  Back to cited text no. 3
[PUBMED]    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]



 

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