A Recent Diabetic with Facial Swelling and Epistaxis

A Recent Diabetic with Facial Swelling and Epistaxis

Vijay Baghel (People’s College of Medical Sciences, India), Reshmi Chanda (People’s College of Medical Sciences, India), Shalini Jadia (People’s College of Medical Sciences, India), Garjesh Rai (People’s College of Medical Sciences, India) and Anil Kapoor (People’s College of Medical Sciences, India)
Copyright: © 2011 |Pages: 2
DOI: 10.4018/ijudh.2011010103
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In this paper, the authors examine and discuss a recent diabetic who presented with hyperglycemia and facial swelling along with nose-bleeding. A prompt diagnostic and therapeutic intervention allowed a rewarding recovery.
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A 45-year-old woman recently detected diabetes, presented with history of fever, headache, swelling over left side of face and loss of sensation over left face since past 10 days. She also had bleeding from right nostril since past three days.

Nasal speculum examination revealed blackish debris and nasal endoscopy revealed white dots (resembling mould) in the nasal cavity along with bilateral crusting of the nasal septum. Sensation was absent in nasal cavity and skin over the left maxillary area.

On admission her blood sugar was 463 mg/dl. (Normal 60-120 Mg/dl)

CT PNS coronal scan (Figure 1A) shows concentric mucosal thickening in left maxillary sinus and soft tissue density in anterior and posterior ethmoid air cells as well as in left sphenoid sinus (Figure 1B).

Figure 1.

CT PNS coronal scan


Microscopic examination of nasal swab on KOH mount showed few budding yeast like cells with pseudohyphae and branching filament (Figure 2A and 2B). Culture of specimen from nasal scraping showed aspergillus flavus (Figure 3A and 3B).

Figure 2.

Microscopic examination of nasal swab on KOH mount


Patient was put on insulin and antifungal (itraconazole) treatment along with local debridement under anesthesia. She also underwent repeated nasal endoscopic cleaning on alternate days for one week. She responded well to the above treatment. Swelling over face, fever, and headache subsided within a week of treatment and finally once her blood sugars were controlled and remained stable, she was discharged.


A. flavus is a prevalent species in India, Pakistan, Qatar and Iran (Hedayati, 2007). Most of the infections are associated with immunocompromised hosts such as patients with diabetes mellitus, hematological malignancy or those receiving chemotherapy.

The preliminary diagnosis is made by nasal endoscopy and a CT imaging but tissue biopsy and culture are of vital importance in confirming the disease and in planning treatment.

Therapy is focused around surgical removal of the damaged tissue along with antifungal therapy. (Carpentier) The present report aims to alert medical personnel toward early detection of the disease in diabetics.

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