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Reconstructive cranial surgery for invasive and non-responsive mucormycosis.

Preetham Dange1, Nazrin Hameed2, Ravi Sankar2

  • 1Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.

BMJ Case Reports
|September 15, 2023
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Summary

A challenging case of invasive fungal sinusitis (mucormycosis) in a diabetic patient with COVID-19 is presented. Advanced surgical techniques and 3D-printed implants successfully managed this persistent infection.

Keywords:
COVID-19DiabetesOtolaryngology / ENT

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Area of Science:

  • Otolaryngology
  • Infectious Diseases
  • Neurosurgery

Background:

  • The COVID-19 pandemic saw increased mucormycosis incidence, particularly in diabetic patients.
  • Corticosteroid and oxygen therapy during COVID-19 treatment are risk factors for invasive fungal infections.

Observation:

  • A persistent case of frontal and ethmoid sinus mucormycosis in a diabetic male with a history of COVID-19.
  • The infection resisted initial endoscopic sinus surgery and re-exploration with antifungal therapy.

Findings:

  • A bifrontal craniotomy with complete sinus exenteration was required for infection control.
  • Reconstruction utilized a custom 3D-printed titanium cranioplasty mesh, which was MRI-compatible.

Implications:

  • This case highlights the aggressive nature of mucormycosis in immunocompromised patients.
  • Advanced surgical reconstruction techniques, including 3D printing, are crucial for managing complex sinonasal fungal infections.