Survival from Rhino-Orbital-Cerebral Mucormycosis in SARS-CoV-2-Positive Diabetic Patients: Two Case Reports.

Autor: Lädrach C; Department of Ear, Nose and Throat Diseases, Head and Neck Surgery, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland., Wartenberg M; Institute of Tissue Medicine and Pathology, University Bern, Bern, Switzerland., Zimmerli S; Department of Infectious Diseases, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland., Anschuetz L; Department of Ear, Nose and Throat Diseases, Head and Neck Surgery, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland., Bohlen S; Department of Neurology, Inselspital, Bern University Hospital, Bern, Switzerland., Ebner J; Department of Cranio-Maxillofacial Surgery, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland., de Gouyon Matignon de Pontouraude CMF; Department of Ophthalmology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland., Caversaccio M; Department of Ear, Nose and Throat Diseases, Head and Neck Surgery, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland., Wagner F; Department of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland.
Jazyk: angličtina
Zdroj: Case reports in neurology [Case Rep Neurol] 2024 Apr 02; Vol. 16 (1), pp. 89-98. Date of Electronic Publication: 2024 Apr 02 (Print Publication: 2024).
DOI: 10.1159/000538539
Abstrakt: Introduction: Rhino-orbital-cerebral mucormycosis (ROCM) is a rare angioinvasive fungal infection known to be associated with high morbidity and over 50% mortality. ROCM is becoming more common due to an increase in predisposing immunocompromising comorbidities as well as COVID-19.
Case Presentations: We report 2 cases - a 75-year-old woman with diabetes and a 39-year-old man with recurrent diabetic ketoacidosis. Both presented initially with acute sinonasal symptoms, were positive for SARS-CoV-2, and diagnosed with acute ROCM. Both underwent mutilating surgical therapy as well as high-dose amphotericin B treatment. With continued oral antifungal treatment, patient 1 showed stable symptoms despite radiographically increasing disease and died of urosepsis 5 months after first surgery. With posaconazole treatment, patient 2 recovered from the disease and showed no clinical sign of disease progression after 1 year.
Conclusion: Despite the rarity of the disease, ROCM should be considered if the findings of clinical and radiological examination fit, so that a delay in treatment initiation can be avoided. As our both cases show, survival from ROCM is possible - albeit at a high cost.
Competing Interests: The authors have no conflicts of interest to declare.
(© 2024 The Author(s). Published by S. Karger AG, Basel.)
Databáze: MEDLINE
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