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Case Reports
. 2022 Mar 15:2022:2537186.
doi: 10.1155/2022/2537186. eCollection 2022.

Rhino-Orbital-Cerebral Mucormycosis in a Post-COVID-19 Patient from Peru

Linda Ponce-Rosas  1 , Jose Gonzales-Zamora  2 , Nelson Diaz-Reyes  3   4 , Oliver Alarco-Cadillo  5 , Jorge Alave-Rosas  3   4
Affiliations
Case Reports

Rhino-Orbital-Cerebral Mucormycosis in a Post-COVID-19 Patient from Peru

Linda Ponce-Rosas et al. Case Rep Infect Dis. .

Abstract

Mucormycosis has been reported increasingly in patients affected by COVID-19, especially in India where the first cases were described. In Latin America, there is limited information about this association, mainly coming from Brazil, Mexico, and Peru. Herein, we report the case of a 66-year-old female that presented with rhino-orbital-cerebral mucormycosis, diabetic ketoacidosis, and COVID-19. The patient had the compromise of all the sinuses, orbital invasion, and intracranial extension. Isavuconazole was promptly initiated because amphotericin B was not available. She had a single open surgical debridement of necrotic tissues at the beginning of the diagnosis then multiple manual sessions to clear the residual or recurrent disease during approximately 5 months. Isavuconazole was effective and well-tolerated for 10 months without side effects. We highlight the importance of considering mucormycosis in post-COVID-19 patients with uncontrolled diabetes. The report emphasizes the favorable outcome of isavuconazole as an alternative therapy.

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Conflict of interest statement

All authors declare that they have no conflicts of interest.

Figures

Figure 1
Figure 1
(a) Paranasal sinuses CT scan showed fluid level of frontal sinuses, (b) mucosal thickening of bilateral maxillary (white arrows) and ethmoid sinuses (red arrows), and (c) mucosal thickening of bilateral ethmoid sinuses (red arrows) and fluid level of bilateral sphenoidal sinuses (white arrows).
Figure 2
Figure 2
Histopathology showing broad, nonseptate hyphae with 90-degree angle branching (hematoxylin and eosin staining, original magnification ×400).
Figure 3
Figure 3
(a) Coronal T1-weighted contrast-enhanced MRI reported frontal anterobasal dural thickening and strong pachymeningeal enhancement (arrows). (b) Fluid attenuated inversion recovery (FLAIR) sequence showed hyperintense signal in cortical anterobasal frontal lobes (arrows). (c) FLAIR sequence revealed an abscess adjacent to the inferior rectus muscle of the left orbit (red arrow).
Figure 4
Figure 4
(a, b) FLAIR sequence showed hyperintense signal in cortical anterobasal frontal lobes (arrows) at the beginning of the treatment (first week). (c, d) FLAIR sequence showed reduced hyperintense signal in cortical anterobasal frontal lobes (arrows) at 5 months follow-up.
See this image and copyright information in PMC

References

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    1. Johns Hopkins University & Medicine. Mortality in the Most Affected Countries . Baltimore, ML, USA: Johns Hopkins University & Medicine; 2022.
    1. Bhatt K., Agolli A., Patel M. H., et al. High mortality co-infections of COVID-19 patients: mucormycosis and other fungal infections. Discoveries . 2021;9(1):p. 126. doi: 10.15190/d.2021.5. - DOI - PMC - PubMed
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    1. Bhattacharyya A., Sarma P., Sharma D. J., et al. Rhino-orbital-cerebral-mucormycosis in COVID-19: a systematic review. Indian Journal of Pharmacology . 2021;53(4):317–327. - PMC - PubMed

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