General Medicine, Nitte University K S Hegde Medical Academy, Mangalore, Karnataka, India
General Medicine, Nitte University K S Hegde Medical Academy, Mangalore, Karnataka, India.
BMJ Case Rep. 2021 Apr 27;14(4):e241663. doi: 10.1136/bcr-2021-241663.
A middle-aged woman with diabetes presented with left-sided facial pain, complete ptosis and fever of short duration. On presentation, she had hyperglycaemia without ketosis. There was total ophthalmoplegia of the left eye with a visual acuity of 6/36. She incidentally tested positive for COVID-19. CT paranasal sinus and MRI brain revealed left-sided pansinusitis with acute infarct in the left parieto-occipital region without angioinvasion. An emergency functional endoscopic sinus procedure was done, which confirmed mucormycosis on histopathological examination. After 1 week of conventional amphotericin B and antibiotics, repeat CT brain showed improvement in mucosal thickening and sinusitis. This case is a rare presentation of mucormycosis associated with rapid progression to orbital apex syndrome with brain infarction in a patient with non-ketotic diabetes and COVID-19. Early diagnosis and treatment are essential to prevent further end-organ damage. It is also interesting that there was no angioinvasion and transient periarterial inflammation was attributed to brain infarction.
一位中年女性，患有糖尿病，表现为左侧面部疼痛、完全性上睑下垂和短暂发热。就诊时，她血糖升高但无酮症。左眼完全眼肌瘫痪，视力为 6/36。她偶然被检测出 COVID-19 阳性。鼻窦 CT 和脑 MRI 显示左侧全鼻窦炎伴左顶枕叶急性梗死，但无血管侵犯。紧急行功能性内镜鼻窦手术，组织病理学检查证实为毛霉菌病。常规两性霉素 B 和抗生素治疗 1 周后，复查脑 CT 显示黏膜增厚和鼻窦炎改善。本例为非酮症糖尿病合并 COVID-19 患者中罕见的毛霉菌病表现，迅速进展为眶尖综合征并伴有脑梗死。早期诊断和治疗对于预防进一步的靶器官损伤至关重要。此外，有趣的是没有血管侵犯，而短暂的动脉周围炎症归因于脑梗死。
