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A 40-Year-Old Woman With COVID-19 and Bilateral Vision Loss
Varun Jain1, Alexander J Senetar1, Carolina B Maciel2
1Department of Neurology, University of Florida College of Medicine, Gainesville, FL, USA.
The Neurohospitalist
|September 23, 2022
Summary
Mucormycosis, a dangerous fungal infection, is increasingly linked to COVID-19 treatments like steroids. Early diagnosis using cell-free DNA sequencing is crucial but challenging, as highlighted by a fatal case report.
Area of Science:
- Mycology
- Infectious Diseases
- Neurology
Background:
- Mucormycosis is a severe angioinvasive fungal infection with high mortality.
- Risk factors include immunodeficiency, diabetes, iron overload, stem cell transplant, and steroid use.
- COVID-19 associated mucormycosis (CAM) has emerged as a significant clinical concern, particularly in developing nations.
Purpose of the Study:
- To highlight the clinical presentation and diagnostic challenges of COVID-19 associated mucormycosis.
- To emphasize the utility of next-generation sequencing of cell-free DNA (cfDNA) in diagnosing invasive fungal infections.
- To present a case illustrating the rapid progression and poor prognosis of CAM.
Main Methods:
- Case report of a patient treated with steroids for COVID-19.
- Clinical examination, neuroimaging (leptomeningeal, vascular, and subcortical enhancement, multifocal infarction).
- Paranasal sinus biopsy and next-generation sequencing of cfDNA for pathogen identification.
Main Results:
- The patient developed severe neurological complications including bilateral vision loss, ophthalmoplegia, and coma.
- Imaging revealed characteristic patterns of central nervous system involvement.
- Biopsy confirmed fungal elements, and cfDNA sequencing identified Rhizopus species.
Conclusions:
- COVID-19 associated mucormycosis is a critical, rapidly progressing infection.
- Cell-free DNA sequencing offers a valuable diagnostic tool for invasive fungal infections.
- Despite treatment with amphotericin B, the patient succumbed to the infection, underscoring the severity of CAM.
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