Eswaran Sudhagar, Balan Sarath Kumar, Saravanam Prasanna Kumar
Department of ENT, Head and Neck Surgery, Sri Ramachandra Institute of Higher Education and Research, Chennai, India.
Indian J Otolaryngol Head Neck Surg. 2022 Oct;74(Suppl 2):3442-3446. doi: 10.1007/s12070-021-02689-4. Epub 2021 Jul 8.
Covid 19 infection can result in various opportunistic infections. Altered immune response, associated comorbid conditions like diabetes, prolonged steroid and broad spectrum antibiotics usage with ICU interventions lead to increased chance of such superadded infections in covid 19 patients. Here we report a case of 31 year old male with covid 19 infection who had new onset Diabetes Mellitus, developed severe acute fulminant Mucormycosis during the treatment for covid 19 infection. He presented with severe headache, nasal obstruction and discharge, bilateral ophthalmoplegia and blindness with Cavernous Sinus Thrombosis. Patient underwent aggressive surgical debridement with frontal craniectomy, maxillectomy and right orbital evisceration and left endoscopic orbital decompression and judicious efforts to revert back the immunocompromised status with high dose of Liposomal amphotericin. Post operatively patient developed right temporal lobe abscess which was drained through Endonasal Endoscopic Trans Cavernous drainage of Temporal Lobe Abscess. Patient is in 2 months follow up, with bilateral blindness and tolerating oral feeds with improved left eye ophthalmoplegia. It is imperative to note that the rising trend of mucormycosis is there in Covid 19 infections and it should be dealt with high index of suspicion in high risk patients and early aggressive treatment can save the patient as the survival rate is not high in such infections.
新型冠状病毒肺炎（Covid - 19）感染可导致各种机会性感染。免疫反应改变、糖尿病等相关合并症、长期使用类固醇和广谱抗生素以及重症监护病房（ICU）干预措施，导致Covid - 19患者发生此类叠加感染的几率增加。在此，我们报告一例31岁男性Covid - 19感染患者，该患者在Covid - 19感染治疗期间新发糖尿病，并发展为严重急性暴发性毛霉菌病。他表现为严重头痛、鼻塞和流涕、双侧眼球运动麻痹以及伴有海绵窦血栓形成的失明。患者接受了积极的手术清创，包括额骨切除术、上颌骨切除术和右眼眼球摘除术以及左内镜下眼眶减压术，并通过大剂量脂质体两性霉素明智地努力恢复免疫功能低下状态。术后患者出现右颞叶脓肿，通过经鼻内镜经海绵窦引流颞叶脓肿进行了引流。患者处于2个月的随访期内，双眼失明，能耐受经口进食，左眼眼球运动麻痹有所改善。必须注意的是，毛霉菌病在Covid - 19感染中的上升趋势存在，对于高危患者应高度怀疑，并尽早进行积极治疗，因为此类感染的生存率不高，早期积极治疗可挽救患者生命。
