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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
PubMed

Insights

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.
Keywords:
COVID-19MucormycosisSARS-CoV2basal ganglia necrosisvision loss

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