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de Guimarães JA, Boasquevisque GS, Gaspar GG, Podolsky-Gondim GG, Mello FLV, Valera FCP, Chahud F, Cruz AAVE. Progressive chronic calvarial osteomyelitis in rhino-orbital mucormycosis associated with COVID-19. Orbit 2024; 43:119-125. [PMID: 35642653 DOI: 10.1080/01676830.2022.2080233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 05/16/2022] [Indexed: 10/18/2022]
Abstract
We describe two cases of extensive indolent calvarial osteomyelitis after rhino-orbital-mucormycosis in diabetic patients previously diagnosed with COVID-19. Both patients presented with acute rhino-orbital symptoms about one month after being diagnosed with COVID-19. Treatment with intravenous liposomal Amphotericin B and prompt radical surgical debridement was instituted, but calvarial osteomyelitis ensued and persisted chronically despite maintenance of antifungal therapy and partial debridement of necrotic calvarial bone. The patients were discharged to continue antifungal therapy on a day-hospital regime. After more than 8 months of treatment, they remain with radiological signs of osteomyelitis but with no symptoms or intracranial extension of the infection. Calvarial indolent osteomyelitis secondary to mucormycosis is extremely rare, and little is known regarding its treatment. We believe it can be controlled with medical treatment and partial bony debridement although more studies are necessary to better define therapy.
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Affiliation(s)
- Juliana Albano de Guimarães
- Division of Ophthalmology, Department of Ophthalmology, Otorhinolaryngology, and Head and Neck Surgery, School of Medicine of Ribeirão Preto - University of São Paulo, São Paulo, Brazil
| | | | - Gilberto Gambero Gaspar
- Division of Infectious Diseases, Department of Internal Medicine, School of Medicine of Ribeirão Preto - University of São Paulo, São Paulo, Brazil
| | - Guilherme Gozzoli Podolsky-Gondim
- Division of Neurosurgery, Department of Surgery and Anatomy, School of Medicine of Ribeirão Preto - University of São Paulo, São Paulo, Brazil
| | - Fábio Longarini Veríssimo Mello
- Division of Head and Neck Surgery, Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, School of Medicine of Ribeirão Preto - University of São Paulo, São Paulo, Brazil
| | - Fabiana Cardoso Pereira Valera
- Division of Otorhinolaryngology, Department of Ophthalmology, Otorhinolaryngology, and Head and Neck Surgery, School of Medicine of Ribeirão Preto - University of São Paulo, São Paulo, Brazil
| | - Fernando Chahud
- Department of Pathology, School of Medicine of Ribeirão Preto - University of São Paulo, São Paulo, Brazil
| | - Antonio Augusto Velasco E Cruz
- Division of Ophthalmology, Department of Ophthalmology, Otorhinolaryngology, and Head and Neck Surgery, School of Medicine of Ribeirão Preto - University of São Paulo, São Paulo, Brazil
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Tabari A, Farrokh F, Zeinalizadeh M, Nasirmohtaram S, Tabari A, Salehi M, Pakdel F, Salahshour F, Saffar H, Mirashrafi F, Sadrehosseini SM. Skull base osteomyelitis: A case report of Garcin syndrome due to mucormycosis in COVID pandemic. IDCases 2023; 33:e01827. [PMID: 37448379 PMCID: PMC10336253 DOI: 10.1016/j.idcr.2023.e01827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 06/19/2023] [Accepted: 06/23/2023] [Indexed: 07/15/2023] Open
Abstract
Garcin syndrome is characterized by progressive unilateral multiple cranial nerve palsy without the presence of intracranial hypertension. In this case, we present a patient who experienced lower cranial nerve (CN 9-12) involvement attributed to post-mucormycosis osteomyelitis of the skull base. The osteomyelitis resulting from mucormycosis led to the development of Garcin syndrome, which manifested as progressive paralysis of the cranial nerves. It is important to recognize this rare complication and consider it in the differential diagnosis when evaluating patients with lower cranial nerve palsy following mucormycosis-related skull base osteomyelitis.
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Affiliation(s)
- Azin Tabari
- Otorhinolaryngology Research Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Fatemeh Farrokh
- Otorhinolaryngology Research Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Mehdi Zeinalizadeh
- Neurosurgery and Skull Base Surgery, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Sevil Nasirmohtaram
- Otorhinolaryngology Research Center, Guilan University of Medical Sciences, Rasht, Islamic Republic of Iran
| | - Amir Tabari
- School of Medicine, Azad University of Medical Sciences, Mashhad, Islamic Republic of Iran
| | - Mohammadreza Salehi
- Department of Infectious Diseases and Tropical Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Farzad Pakdel
- Farabi Hospital, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Faeze Salahshour
- Department of Radiology, Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Imam Khomeini Hospital Complex, Tehran University of Medical Sciences (TUMS), Tehran, Islamic Republic of Iran
| | - Hana Saffar
- Anatomical and Clinical Pathology, Cancer Institute, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Fatemeh Mirashrafi
- Otorhinolaryngology Research Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Seyed Mousa Sadrehosseini
- Otorhinolaryngology Research Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
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Yadav S, Saini A, Singh A, Verma H. Batwing incision for a case of bilateral fungal zygomatic osteomyelitis. BMJ Case Rep 2022; 15:15/5/e247387. [PMID: 35641085 PMCID: PMC9157357 DOI: 10.1136/bcr-2021-247387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Zygomatic osteomyelitis is a rare occurrence due to rich collateral blood supply of bone. A man in his 30s presented with complaints of pain over bilateral cheek and pus discharge below the eye on lateral aspect. He was a known case of COVID-19 associated mucormycosis postendoscopic debridement of sinuses 3 months back. Radiology revealed bilateral destruction of zygoma with discharging sinus. Microbiological analysis confirmed aseptate hyphae in pus, and a diagnosis of bilateral fungal zygomatic osteomyelitis made. Under general anaesthesia, sequestrectomy done using bilateral lateral rhinotomy with extended Dieffenbach’s approach (batwing incision). Postsurgery 3000 mg of liposomal amphotericin was administered. There was no enophthalmos or restricted eye movements postoperatively. Follow-up MRI suggested minimal inflammatory enhancement in maxillary sinus. Patient was discharged on oral antifungals.
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Affiliation(s)
- Sanjeev Yadav
- ENT & head and neck surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Ashish Saini
- ENT & head and neck surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Abhimanyu Singh
- ENT & head and neck surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Hitesh Verma
- ENT & head and neck surgery, All India Institute of Medical Sciences, New Delhi, India
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Koehler P, Tacke D, Cornely OA. Bone and joint infections by Mucorales, Scedosporium, Fusarium and even rarer fungi. Crit Rev Microbiol 2014; 42:158-71. [DOI: 10.3109/1040841x.2014.910749] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Philipp Koehler
- Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany,
- Center for Integrated Oncology CIO Köln/Bonn, Medical Faculty, University of Cologne, Cologne, Germany,
- Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Medical Faculty, University of Cologne, Cologne, Germany,
| | - Daniela Tacke
- Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany,
- Center for Integrated Oncology CIO Köln/Bonn, Medical Faculty, University of Cologne, Cologne, Germany,
| | - Oliver A. Cornely
- Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany,
- Center for Integrated Oncology CIO Köln/Bonn, Medical Faculty, University of Cologne, Cologne, Germany,
- Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Medical Faculty, University of Cologne, Cologne, Germany,
- Clinical Trials Centre Cologne, ZKS Köln, BMBF 01KN1106, Medical Faculty, University of Cologne, Cologne, Germany, and
- German Centre for Infection Research (DZIF), partner site Bonn-Cologne, Cologne, Germany
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