Abstract
Background: Unilateral destructive sinonasal disease in a patient with uncontrolled diabetes immediately raises concern for rhino-maxillary mucormycosis. Because invasive fungal infection can progress rapidly, early recognition and tissue diagnosis are essential. However, chronic maxillary osteomyelitis may present with a very similar clinical and radiologic picture.
Case Presentation: A 55-year-old woman with poorly controlled type 2 diabetes mellitus presented with left-sided facial discomfort, unilateral nasal obstruction, foul oral odor, and leakage of fluids from the mouth into the nose. Examination revealed unhealthy mucosa over the left maxillary palate, exposed necrotic bone, and an oronasal fistula. Non-contrast CT of the paranasal sinuses showed unilateral left-sided sinonasal soft tissue thickening with destructive bony changes involving the maxillary antrum, hard palate, nasal septum, and adjacent skull-base region, raising strong concern for invasive fungal sinusitis. She was admitted and managed with broad-spectrum intravenous antibiotics, insulin therapy, and urgent tissue sampling. Histopathology showed necrotic and sclerotic bony trabeculae, empty osteocyte lacunae, chronic inflammatory infiltrate, and bacterial colonies, while fungal stains were negative. A deep tissue culture obtained before antibiotics showed mixed aerobic and anaerobic oral flora. These findings supported a diagnosis of chronic maxillary osteomyelitis with secondary palatal breakdown rather than tissue-proven fungal invasion.
Conclusion: In diabetic patients, destructive maxillofacial lesions should not be assumed to represent mucormycosis without tissue confirmation. Chronic maxillary osteomyelitis may closely mimic invasive fungal sinusitis on clinical examination and imaging, and histopathologic evaluation is essential to guide appropriate treatment.
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Copyright (c) 2026 Dr. Umer Farooq Khan MBBS, FCPS, Muhammad Saqib, MD, Dr. Jawad Ahmed, MBBS, Aneesa Altaf, MBBS (Author)