Invasive rhinocerebral mucormycosis:Imaging the temporal evolution of disease in post COVID-19 case with diabetes:A case report

BACKGROUND Rhinocerebral mucormycosis(RCM)is a rare,fatal,invasive fungal infection infecting mainly patients with immunocompromised conditions,such as diabetes mellitus,hematologic malignancies,and organ transplantations.Coronavirus disease 2019(COVID-19)disease in these patients further weakens the immune system due to several factors,including hypoxia,corticosteroid usage(further increasing hyperglycemic status),mechanical ventilation,increased serum ferritin levels,endothelitis due to free radicals,and glucose receptor protein upregulation.Timely diagnosis,judicious treatment decisions,and diabetes control with proper treatment guidelines in patients with coexisting COVID-19 disease can reduce complication rates and improve survival.CASE SUMMARY A 75-year-old male patient with diabetes and hypertension diagnosed with COVID-19 presented to the emergency department.Laboratory examinations revealed elevated blood glucose levels,as well as ketone bodies in the urine.He was treated with oxygen and steroids,as well as insulin to correct blood glucose levels.He complained of a headache 10 d later,and imaging demonstrated mucosal thickening in bilateral sphenoidal,ethmoidal,and maxillary sinuses with hyperdense foci in the right maxillary sinus but without central nervous system involvement.Surgical debridement was performed,and a histopathological study revealed fungi hyphae.Systemic antifungals(amphotericin b and posaconazole)were administered.Subsequently,on 15th day he developed right lower limb weakness and left lateral rectus palsy.There was slow but steady progress,and he was discharged.However,he presented to emergency department 1mo later with altered sensorium and poor control of diabetes resulted in an intracranial spread of mucormycosis,which ultimately led to the patient’s poor prognosis and slow recovery.CONCLUSION Prompt early diagnosis,judicious treatment decisions,and diabetes control with proper treatment guidelines are necessary in patients with COVID-19 associated invasive RCM to reduce complication rates and improve patient survival.

Rhinocerebral mucormycosis caused by Rhizopus oryzae in a patient with acute myeloid leukemia: A case report

BACKGROUND Rhinocerebral mucormycosis(RCM)is a rare fatal fungal infection which is on the increase among immunocompromised hosts such as patients who have had hematological cancers,or have received immunosuppressive drugs,corticosteroids,or other T cell suppressing agents.CASE SUMMARY We report a case of RCM caused by Rhizopus oryzae,one of the most common opportunistic pathogens,in a patient suffering from a fourth relapse of acute myeloid leukemia.The patient developed RCM after he had received long-term antibiotic agents and corticosteroids.The pathogen was isolated three times from nasal secretions collected from the deep parts of the nasal cavity and was identified by morphology and internal transcribed spacer sequencing.Blood infection was excluded by droplet digital polymerase chain reaction and blood culture.The patient was empirically treated with caspofungin and voriconazole for several days while the lesions continued to progress.The patient was given amphotericin B in combination with caspofungin after RCM was suspected,and the lesions improved over the course of treatment,which lasted several days.However,the patient eventually died of the primary disease.CONCLUSION This case indicates that immunosuppressive drugs,including corticosteroids and antimetabolites in hematological tumor,do increase the risk of infections of this type.Early diagnosis,prompt and frequent surgical debridement,and treatment with amphotericin B without delay are all essential in combatting RCM.