PMC10191744_01
Facial anomality in patient (a) facial swelling (b) nasal deformity.
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On physical examination, she had right-sided facial swelling, right eye proptosis with conjunctival redness, saddle-shaped nose deformity, bilateral polypoid growth, right-sided lower motor type of facial nerve palsy (Figures 1(a) and 1(b)), and sensorineural hearing loss on the same side.
(a) X-ray chest (b) high-resolution computerized tomography (HRCT).
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Anteroposterior (AP) chest X-ray revealed bilateral multiple nodular opacities and thick-walled cavities (Figure 2(a)). High-resolution computerized tomography (HRCT) showed bilateral multiple large cavitating soft tissue nodules with some air-fluid levels (Figure 2(b)), and computerized tomography (CT)-scan paranasal sinuses revealed nodular mucosal thickenings in bilateral nasal cavities with widening and destruction of right osteomeatal complex and pansinusitis (Figure 3).
Computerized tomography (CT)-scan paranasal sinuses with sinuses with the area shown in the red star reveal nodular mucosal thickening in bilateral nasal cavities with widening and *showing destruction of right osteomeatal complex and pansinusitis.
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High-resolution computerized tomography (HRCT) showed bilateral multiple large cavitating soft tissue nodules with some air-fluid levels (Figure 2(b)), and computerized tomography (CT)-scan paranasal sinuses revealed nodular mucosal thickenings in bilateral nasal cavities with widening and destruction of right osteomeatal complex and pansinusitis (Figure 3).
(a) H&E stain, (b) periodic acid-Schiff (PAS) stain, (c) grocott methamine silver stain showing long fibers of broad non-septate hyphae branching at 90 degrees (red arrows).
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A nasal mucosa biopsy revealed a necrotic slough with wide-angle branching fungal hyphae suggestive of mucormycosis (Figure 4).
The patient's facial image shows marked improvement on a follow-up visit.
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LAm-B 3 mg/kg/day in 2 divided doses for a month, and oral steroids, which were tapered off gradually.  Figure 5 shows improved facial symptoms on a follow-up visit. Laboratory workup on follow-up showed improved inflammatory markers and renal function tests.