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Survival from Rhino-Orbital-Cerebral Mucormycosis in SARS-CoV-2-Positive Diabetic Patients: Two Case Reports
Claudia Lädrach1, Martin Wartenberg2, Stefan Zimmerli3
1Department of Ear, Nose and Throat Diseases, Head and Neck Surgery, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland.
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.
Insights
Rhino-orbital-cerebral mucormycosis (ROCM) is a severe fungal infection. Early diagnosis and treatment are crucial for survival, as demonstrated by two COVID-19-associated cases with different outcomes.
Area of Science:
- Infectious Diseases
- Mycology
- Critical Care Medicine
Background:
- Rhino-orbital-cerebral mucormycosis (ROCM) is a rare but life-threatening angioinvasive fungal infection.
- Increasing incidence linked to immunocompromising conditions and COVID-19.
Observation:
- Two cases of ROCM are presented: a 75-year-old woman with diabetes and a 39-year-old man with diabetic ketoacidosis.
- Both patients had SARS-CoV-2 infection, acute sinonasal symptoms, and ROCM diagnosis.
- Treatment involved surgery and high-dose amphotericin B, with varied outcomes.
Findings:
- Patient 1, despite treatment, progressed and died from urosepsis.
- Patient 2 recovered with posaconazole treatment, showing no disease progression after one year.
- Outcomes highlight the variability in ROCM response to treatment.
Implications:
- ROCM should be considered in patients with compatible clinical and radiological findings, especially those with risk factors.
- Prompt diagnosis and initiation of treatment are critical for improving survival rates.
- Aggressive management, including antifungal therapy and surgical debridement, is essential.
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