A Recent Diabetic with Facial Swelling and Epistaxis

Introduction

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.