Chugh Ankita, Pandey Akhilesh Kumar, Goyal Amit, Soni Kapil, Jain Vidhi, Thirunavukkarasu Balamurugan, Vedant Deepak, Kumar Deepak, Kumar Pravin
Department of Dentistry, Oral and Maxillofacial Surgery, All India Institute of Medical Sciences, Jodhpur, India.
Department of Otorhinolaryngology, All India Institute of Medical Sciences, Jodhpur, India.
J Oral Maxillofac Surg Med Pathol. 2022 Sep;34(5):622-627. doi: 10.1016/j.ajoms.2022.03.007. Epub 2022 Apr 4.
Mucormycosis and Aspergillosis are opportunistic fungal infections causing significant morbidity and mortality. Post the outbreak of COVID-19, these fungal osteomyelitis have seen a global rise with few atypical presentations noted.
Current case series reports three such atypical presentations of fungal osteomyelitis including mandibular fungal osteomyelitis in two patients, fungal osteomyelitis mimicking space infection in a middle aged male, and suspected mixed fungal osteomyelitis involving maxillary sinus. Aggressive surgical debridement was indicated along with institution of antifungal therapy (Liposomal Amphotericin B, and Posaconazole). The fungal osteomyelitis was successfully treated with surgical and medical management with no recurrence.
The injudicious use of corticosteroids in COVID-19 patients along with their immunocompromised status increases their susceptibility to opportunistic fungal osteomyelitis. Prompt and aggressive surgical intervention along with antifungal therapy is important after diagnosing fungal osteomyelitis, as a delay could increase the mortality rate considerably.
毛霉病和曲霉病是机会性真菌感染，可导致严重的发病率和死亡率。在新冠疫情爆发后，这些真菌性骨髓炎在全球范围内有所增加，且出现了一些非典型表现。
当前病例系列报道了三例真菌性骨髓炎的非典型表现，包括两名患者的下颌骨真菌性骨髓炎、一名中年男性疑似模拟间隙感染的真菌性骨髓炎以及累及上颌窦的疑似混合性真菌性骨髓炎。除了开始抗真菌治疗（脂质体两性霉素B和泊沙康唑）外，还需要积极的手术清创。通过手术和药物治疗，真菌性骨髓炎得到了成功治疗，且无复发。
新冠患者中不恰当地使用皮质类固醇及其免疫功能低下状态增加了他们对机会性真菌性骨髓炎的易感性。诊断真菌性骨髓炎后，及时、积极的手术干预和抗真菌治疗很重要，因为延迟治疗可能会大幅增加死亡率。
