Functional Endoscopic Sinus Surgery for Rhino-orbital mucormycosis in a pediatric patient with Acute Lymphocytic Leukemia- Anaesthetic considerations
Vol 5 | Issue 3 | Sep-Dec 2019 | page: 13-15 | Akhilesh Pahade, Itee Chowdhury, Amit Kumar Mittal, Ashita Mowar
Authors: Akhilesh Pahade , Itee Chowdhury , Amit Kumar Mittal , Ashita Mowar 
Address of Correspondence
1Department of Anaesthesia, Rajiv Gandhi Cancer Institute, Rohini, Delhi, India.
2Department of Anaesthesia, SRMS IMS, Barielly, Uttarpradesh, India.
Dr. Akhilesh Pahade,
Rajiv Gandhi Cancer Institute, Rohini, Delhi, India.
Disseminated rhinocerebral mucormycosis is a lethal form of invasive fungal infection. Predisposing factors include immuno suppressed patients, diabetic ketoacidosis. Effective management consists of high index of suspicion, cytological diagnosis, optimization of comorbidities, systemic antifungal therapy with prompt surgical debridement of infected tissue. Our patient was a known case of acute lymphocytic leukemia (ALL) of pediatric age undergoing chemotherapy and presented with high grade fever and epistaxis. Following a confirmatory cytology from nasal cavity his general condition was optimized and surgical (Functional endoscopic sinus surgery (FESS) debridement done. Here we present the anaesthetic challenges in a patient of ALL affected with mucormycosis with multiple comorbidities highlighting airway management.
Keywords: Rhino cerebral mucormycosis, Acute lymphocytic leukemia, Diabetic ketoacidosis, Amphotericin B, Functional endoscopic sinus surgery, Difficult airway
1. Prabhu R M,Patel R. Mucormycosis and entomophthoramycosis: a review of the clinical manifestations, diagnosis and treatment. Clin Microbiol Infect 2004;vol.10 Suppl(pg.31-47)
2. Breiman A, Sadawsky D, Friedman J. Mucormycosis discussion and report of a case involving the maxillary sinus. Oral SurgOral Med Oral Pathol 1981; 52: 375-378.
3. Kulkarni PK, Reddy NB, Shrinivas B, Takkalki VV. Anesthetic considerations in the management of mucormycosis. Int J Med Public Health 2015;5:387-90.
4. Komali Garlapati, Sunanda Chavva, Rahul Marshal Vaddeswarupu, and Jyotsna Surampudi, “Fulminant Mucormycosis Involving Paranasal Sinuses: A Rare Case Report,” Case Reports in Dentistry; vol. 2014. Article ID 465919, 4 pages, 2014. doi:10.1155/2014/465919
5. Frater JL, Hall GS, Procop GW. Histologic features of zygomycosis: Emphasis on perineural invasion and fungal morphology. Arch Pathol Lab Med 2001;125:375- 8.
6. Imhof A, Walter RB, Schaffner A. Continuous infusion of escalated doses of amphotericin B deoxycholate: An open-label observational study. Clin Infect Dis 2003;36:943-51.
7. Hirakawa, M. , Makino, K. , Nakashima, K. , Kataoka, Y. and Oishi, R. (1999), Evaluation of the in‐line filters for the intravenous infusion of amphotericin B fluid. Journal of Clinical Pharmacy and Therapeutics, 24: 387-392.
8. Gilbert Deray; Amphotericin B nephrotoxicity, Journal of Antimicrobial Chemotherapy, Volume 49, Issue suppl_1, 1 January 2002, Pages 37–41, https://doi.org/10.1093/jac/49.suppl_1.37
9. Dash AK , Arora V, Nagarkar NM. Rhino-orbital mucormycosis. Natl J Otorhinolaryngol Head Neck Surg 2013;10:5-6
10. Eckmann David M, Seligman Ilana , Cote Charles J, Hussong Jerry W.Mucormycosis Supraglottitis on Induction of Anesthesia in an Immunocompromised Host. Anesthesia & Analgesia. 86(4):729-730, April 1998
11.Mucormycosis risk and prevention. Centers for disease control. Available from : https://www.cdc.gov/fungal/diseases/mucormycosis/risk-prevention.html
|How to Cite this Article:Pahade A, Chowdhury I, Mittal A, Mowar A. | Functional Endoscopic Sinus Surgery for Rhino-orbital mucormycosis in a pediatric patient with Acute Lymphocytic Leukemia- Anaesthetic considerations. | Journal of Anaesthesia and Critical Care Case Reports | Sep – Dec 2019; 5(3): 13-15.|
.Tags: Acute lymphocytic leukemia, Amphotericin B, Diabetic ketoacidosis, Difficult airway, Functional endoscopic sinus surgery, Rhino cerebral mucormycosis