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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Mittal A, Mahajan N, Pal Singh Dhanota D, Paul BS, Ahluwalia S, Ahluwalia S, Galhotra A, Gupta V, Puri S, Verma R, Munjal M, Goel S, Chopra S, Mahajan R, Ahluwalia A, Saggar K, Singh G. SARS-CoV-19-associated Rhino-orbital and cerebral Mucormycosis: Clinical and Radiological Presentations. Med Mycol 2022; 60:6677975. [PMID: 36029277 PMCID: PMC9494327 DOI: 10.1093/mmy/myac045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 06/06/2022] [Accepted: 08/26/2022] [Indexed: 11/24/2022] Open
Abstract
We describe presenting clinical and imaging manifestations of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2)-associated Rhino-oculo-cerebral mucormycosis (ROCM) in a hospital setting during the second wave of SARS-CoV-2 pandemic in India. Data on the presenting manifestations were collected from 1 March to 31 May 2021. Associations between clinical and imaging findings were explored, specifically: (1) the presence or absence of orbital pain and infiltration of a superior orbital fissure on imaging; (2) the presence of unilateral facial nerve palsy and pterygopalatine fossa infiltration and geniculate ganglion signal on contrast magnetic resonance imaging, and (3) vision loss and optic nerve findings on imaging. Orbital pain was reported by 6/36 subjects. A fixed, frozen eye with proptosis and congestion was documented in 26 (72%), complete vision loss in 23 (64%), and a unilateral lower motor neuron facial nerve palsy in 18 (50%). No association was found between the presence of orbital pain and superior orbital fissure infiltration on imaging. The ipsilateral geniculate ganglion was found to enhance more profoundly in 7/11 subjects with facial palsy and available magnetic resonance (MR) imaging, and the ipsilateral pterygopalatine fossa was found infiltrated in 14. Among 23 subjects with complete loss of vision, 9 (39%) demonstrated long-segment bright signal in the posterior optic nerve on diffusion MR images. We conclude that orbital pain might be absent in SARS-CoV-2-associated ROCM. Facial nerve palsy is more common than previously appreciated and ischemic lesions of the posterior portion of the optic nerve underlie complete vision loss.
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Affiliation(s)
- Ashima Mittal
- Department of Radiodiagnosis and Imaging, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Nitika Mahajan
- Department of Neurology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Devinder Pal Singh Dhanota
- Department of Radiodiagnosis and Imaging, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Birinder S Paul
- Department of Neurology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Srishti Ahluwalia
- MBBS student, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Saumya Ahluwalia
- MBBS student, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Arnav Galhotra
- MBBS student, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Veenu Gupta
- Department of Microbiology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Sanjeev Puri
- Department of Otorhinolaryngology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Rohit Verma
- Department of Otorhinolaryngology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Manish Munjal
- Department of Otorhinolaryngology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Sahil Goel
- Department of Ophthalmology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Sumeet Chopra
- Department of Ophthalmology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Rajesh Mahajan
- Department of Internal Medicine, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Archana Ahluwalia
- Department of Radiodiagnosis and Imaging, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Kavita Saggar
- Department of Radiodiagnosis and Imaging, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Gagandeep Singh
- Department of Neurology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India.,University College London Hospitals Biomedical Research Centre, National Institute for Health Research, Queen Square Institute of Neurology, London, UK
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Bhattacharyya A, Sarma P, Sharma DJ, Das KK, Kaur H, Prajapat M, Kumar S, Bansal S, Prakash A, Avti P, Thota P, Reddy DH, Gautam BS, Medhi B. Rhino-orbital-cerebral-mucormycosis in COVID-19: A systematic review. Indian J Pharmacol 2021; 53:317-327. [PMID: 34414911 PMCID: PMC8411962 DOI: 10.4103/ijp.ijp_419_21] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Since the onset of COVID-19 pandemic, parallel opportunistic infections have also been emerging as another disease spectrum. Among all these opportunistic infection, mucormycosis has become a matter of concern with its rapid increase of cases with rapid spread as compared to pre-COVID-19 era. Cases have been reported in post-COVID-19-related immune suppression along with the presence of comorbidity which adds on the deadly outcome. There is no systematic review addressing the issue of COVID-19-associated mucormycosis. This is the first systematic review of published studies of mucormycosis associated with COVID-19. The aim was to analyze the real scenario of the disease statement including all the published studies from first November 2019 to 30th June to analyze the contemporary epidemiology, clinical manifestations, risk factor, prognosis, and treatment outcome of COVID-19 associated rhino-orbito-cerebral-mucormycosis. A comprehensive literature search was done in following databases, namely, PubMed, Google Scholar, Scopus, and EMBASE using keywords mucormycosis, rhino orbital cerebral mucormycosis, COVID-19, and SARS-CoV-2 (from November 01, 2019 to June 30, 2021). Our study shows that, while corticosteroids have proved to be lifesaving in severe to critical COVID-19 patients, its indiscriminate use has come with its price of rhino-orbito-cerebral mucormycosis epidemic, especially in India especially in patients with preexisting diabetes mellitus with higher mortality. Corticosteroid use should be monitored and all COVID-19 patients should be closely evaluated/monitored for sequelae of immunosuppression following treatment.
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Affiliation(s)
- Anusuya Bhattacharyya
- Department of Ophthalmology, Government Medical College and Hospital, Bathinda, Punjab, India
| | - Phulen Sarma
- Department of Pharmacology, PGIMER, Bathinda, Punjab, India
| | - Dibya Jyoti Sharma
- Department of Internal Medicine, Silchar Medical College and Hospital, Assam, India
| | - Karuna Kumar Das
- Department of Anaesthesia, Assam Medical College and Hospital, Assam, India
| | - Hardeep Kaur
- Department of Pharmacology, PGIMER, Bathinda, Punjab, India
| | | | - Subodh Kumar
- Department of Pharmacology, PGIMER, Bathinda, Punjab, India
| | - Seema Bansal
- Department of Pharmacology, PGIMER, Bathinda, Punjab, India
| | - Ajay Prakash
- Department of Pharmacology, PGIMER, Bathinda, Punjab, India
| | | | - Prasad Thota
- Scientific Officer, Department of Pharmacology, Indian Pharmacopoeia Commission, Ghaziabad, Uttar Pradesh, India
| | | | | | - Bikash Medhi
- Department of Pharmacology, PGIMER, Bathinda, Punjab, India
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Uraguchi K, Kozakura K, Oka S, Higaki T, Makihara S, Imai T, Doi A, Ohta T, Kariya S, Nishizaki K. A case of rhinocerebral mucormycosis with brain abscess drained by endoscopic endonasal skull base surgery. Med Mycol Case Rep 2020; 30:22-25. [PMID: 33083212 PMCID: PMC7554319 DOI: 10.1016/j.mmcr.2020.09.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 09/06/2020] [Accepted: 09/07/2020] [Indexed: 02/01/2023] Open
Abstract
A 70-year-old Japanese man undergoing remission induction therapy for acute monocytic leukemia (AML-M5b) developed fever and headache, and was started on antibiotics and liposomal amphotericin B (L-AMB). There was no improvement, and computed tomography and contrast-enhanced magnetic resonance imaging revealed acute rhinosinusitis and brain abscess. Successful endoscopic endonasal surgery was performed at this point, providing drainage for the rhinosinusitis and abscess. Histopathological findings showed the mucormycosis.
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Affiliation(s)
- Kensuke Uraguchi
- Department of Otolaryngology-Head and Neck Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.,Department of Otorhinolaryngology, Kochi Health Sciences Center, Kochi, Japan
| | - Kenichi Kozakura
- Department of Otorhinolaryngology, Kochi Health Sciences Center, Kochi, Japan
| | - Satoshi Oka
- Department of Hematology and Blood Transfusion, Kochi Health Sciences Center, Kochi, Japan
| | - Takaya Higaki
- Department of Otolaryngology-Head and Neck Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Seiichiro Makihara
- Department of Otorhinolaryngology, Head and Neck Surgery, Kagawa Rosai Hospital, Kagawa, Japan
| | - Toshi Imai
- Department of Hematology and Blood Transfusion, Kochi Health Sciences Center, Kochi, Japan
| | - Akira Doi
- Department of Otorhinolaryngology, Kochi Health Sciences Center, Kochi, Japan
| | - Tsuyoshi Ohta
- Department of Neurosurgery, Kochi Health Sciences Center, Kochi, Japan
| | - Shin Kariya
- Department of Otolaryngology-Head and Neck Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Kazunori Nishizaki
- Department of Otolaryngology-Head and Neck Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
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