FUNGAL OSTEOMYELITIS OF ZYGOMATICO-MAXILLARY COMPLEX: A CASE REPORT HIGHLIGHTING CLINICO-PATHOLOGICAL APPROACH TO DIABETIC PATIENTS

Abstract

Osteomyelitis of zygomatico-maxillary complex is rare. We present a diabetic patient who initially reported a small cystic swelling on lower orbital margin which on exploration came out to be a subperiosteal cold abscess. No bone erosion could be detected on routine x-rays. The cytology and initial biopsy revealed chronic nonspecific inflammation. Repeated bacterial cultures and staining for AFB were negative. Later a discharging sinus was formed. CT scan suggested osteomyelitis. Conservative surgery with sequestrectomy and debridement was performed. The biopsy revealed necrotic bony fragments along with fungal hyphae and spores. On fungal culture a growth of Aspergillus flavus was obtained. A final diagnosis of fungal osteomyelitis of lateral part of lower orbital margin involving zygomatico-maxillary complex was made. Patient responded to conservative treatment with oral antifungal agents and minimal surgical intervention. The possibility of fungal etiology must be considered in a diabetic patient even at unusual sites.