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Post-Coronavirus Disease-2019 Rhino-orbital Mucormycosis: A Case Report
Tina Shrestha1, Sanket Parajuli, Rajani Keshari
1Department of Ophthalmology, Dhulikhel Hospital, Dhulikhel, Kavrepalanchok, Nepal.
Background:
Rhino-orbital-cerebral mucormycosis (ROCM) is a rare, opportunistic, angio-invasive, and fatal infection caused by mold fungi of the genera Rhizopus, Mucor, and Rhizomucor. The global incidence of ROCM is 0.005-1.7 per million, with a fatality rate of 46%. Early diagnosis and treatment are crucial for this disease, as a delay of one week can increase the mortality rate to 66%.
Case:
A 32-year-old male, a known case of coronavirus disease 2019 (COVID-19) for the past 15 days from Janakpur, Dhanusha, Nepal presented to the emergency department of Dhulikhel Hospital with a sudden onset of blurred vision in the left eye, left-sided ocular pain, and nasal bleeding for the last three days.
Observations:
The patient was suspected of post-COVID-19 mucormycosis, and a nasal swab for potassium hydroxide (KOH) mount showed hyphae in microscopy. Intravenous and retrobulbar liposomal amphotericin B were administered as medical therapy, along with surgical debridement. A multidisciplinary approach was necessary for the treatment.
Conclusion:
A long-term, multimodal treatment approach involving combined antifungal drug therapy (intravenous liposomal amphotericin B and retrobulbar amphotericin B), and timely surgical debridement leads to an improvement in both short-term and long-term outcomes.
Insights
Rhino-orbital-cerebral mucormycosis (ROCM) is a fatal fungal infection. Early diagnosis and a multimodal treatment approach, including antifungal drugs and surgery, improve patient outcomes.
Area of Science:
- Infectious Diseases
- Ophthalmology
- Neurology
Background:
- Rhino-orbital-cerebral mucormycosis (ROCM) is a rare, aggressive fungal infection with high mortality.
- Incidence is low globally, but delayed treatment significantly increases fatality rates.
Observation:
- A COVID-19 patient presented with sudden vision loss, ocular pain, and nasal bleeding.
- Microscopy confirmed fungal hyphae, suspecting post-COVID-19 mucormycosis.
Findings:
- Treatment involved intravenous and retrobulbar liposomal amphotericin B.
- Surgical debridement and a multidisciplinary approach were crucial.
Implications:
- Multimodal treatment combining antifungals and surgery improves ROCM outcomes.
- Timely intervention is critical for managing this severe opportunistic infection.
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