Yazıcı et al. M. morganii in sinonasal region 383 J Clin Exp Invest www.jceionline.org Vol 4, No 3, September 2013 1 Mardin General Hospital, Department of Ear-Nose-Throat Diseases, Mardin, Turkey 2 Fulya Acıbadem Private Hospital, Department of Ear-Nose-Throat Diseases, İstanbul, Turkey 3 Mardin Park Private Hospital, Department of Ear-Nose-Throat Diseases, Mardin, Turkey 4 Dicle University, Regional Blood Center, Microbiology Laboratory, Diyarbakır, Turkey Correspondence: Yusuf Baygit, Mardin Park Private Hospital, Department of Ear-Nose-Throat Diseases, Mardin, Turkey Email: baygit1@yahoo.com Received: 15.08.2012, Accepted: 23.03.2013 Copyright © JCEI / Journal of Clinical and Experimental Investgatons 2013, All rights reserved JCEI / 2013; 4 (3): 383-386 Journal of Clinical and Experimental Investgatons doi: 10.5799/ahinjs.01.2013.03.0309 CASE REPORT / OLGU SUNUMU Morganella morganii in sinonasal region: A rare case report Sinonazal bölgede Morganella morganii: Nadir bir olgu sunumu Haşmet Yazıcı 1 , Sedat Doğan 1 , İlknur Haberal Can 2 , Yusuf Baygit 3 , Alicem Tekin 4 ÖZET Morganella morganii, özellikle immunsupresif, uzun dö- nem idrar yolu kateteri kullanan kişilerde ölümcül hasta- lıklara yol açabilen Gram-negatif fırsatçı bir patojendir. Sıklıkla üriner sistem enfeksiyonlarına yol açmasına rağ- men kas-iskelet sistemi, santral sinir sistemi ve cilt enfek- siyonlarına da sebep olabilmektedir. Sporadik enfeksiyon olguları nadir olmakla birlikte AİDS, zehirlenmeler ve yılan ısırmaları ile birlikte görülebilmektedir. Sino-kutanöz fstül, preseptal selülit ve oro-maksiller fstül gelişimi görülen, 58 yaşındaki diabetik erkek hastada yapılan tetkikler sonucu M morganii enfeksiyonu saptandı. Hastaya fronto-etmoi- dektomi ve mediyal maksillektomi yapıldı. İki hafta uygu- lanan medikal tedavi sonucu genel durumu düzeldi. Bu olgu, araştırmalarımıza göre sinonazal bölgede ilk kez görülen M. morganii enfeksiyonu olup tanı, tedavi ve klinik yönleriyle tartışılmıştır. Anahtar kelimeler: Morganella morganii, sinonazal fstül, preseptal selülit, kemik defekti ABSTRACT Morganella morganii is a gram negative pathogen and may cause potentially lethal disease especially in patients with underlying or immunosuppressive disease. It is com- monly found in long-term urinary catheter used and im- mune system defciency patients as nosocomial disease. Involving other systems such as skin, skeletal system and central nervous system can be seen too. Sporadic occurrence is rare and can be seen in any system by vari- ous causes like AIDS, snake bites and poisoning. In this case we present sporadic Morganella morganii infection on sinonasal region with the presence of sinusitis, sino- cutaneous fstula, preseptal cellulitis and hard palate de- fect on 58 year old male diabetic patient. Microbiological assessment from open wound and sinuses were reported as Morganella morganii. To our knowledge, this is the frst case of sino-nasal Morganella morganii infection with si- no-cutaneous fstula, preseptal cellulitis and maxillofacial bone destruction. J Clin Exp Invest 2013; 4 (3): 383-386 Key words: Morganella Morganii, sino-nasal fstula, pre- septal cellulitis, bone destruction INTRODUCTION Morganella morganii is a member of Proteae which is included in Enterobacteriaceae family [1]. M. morganii is a Gram-negative opportunistic bacillus which is usually found in the environment and in the intestinal tracts of humans, mammals, and reptiles as normal fora. It has two subgroups named mor- ganii and sibonii. They can cause wound infections, urinary infections usually on patient who have uro- lithiasis, pneumonia, skeletal infections and central nervous system disease [2-4]. Appropriate antibi- otic therapy is important for the best treatment of the disease. Usually they are naturally resistant to many beta-lactam antibiotics and may be resistant to ceftazidime and other third generation cephalo- sporins, but they are susceptible to cefepime, imi- penem, meropenem, piperacillin, aminoglycosides, and fuoroquinolones. Improper antibiotic therapy may lead to delay on diagnosis and it is a predis- posing factor for infection process. In uncomplicat- ed cases mono therapy is usually enough. Combi- nation therapy with two antibiotics (based on sus- ceptibility of organism) is preferred for complicated cases and immune compromised patients. Surgical therapy is indicated for treating underlying disease. CASE A ffty eight-year-old male diabetic patient attended ear-nose-throat clinic with complaints of purulent drainage, hyperemia and swelling on the right side