Iqtadar Somia, Hashmat Masooma, Chaudhry Muhammad Nabeel Akbar, Mumtaz Sami Ullah, Abaidullah Sajid, Pascual-Figal Domingo A, Khan Amjad
Department of Medicine, King Edward Medical University, Lahore, Pakistan.
Punjab Institute of Cardiology, Lahore, Pakistan.
Ther Adv Infect Dis. 2022 May 6;9:20499361221097417. doi: 10.1177/20499361221097417. eCollection 2022 Jan-Dec.
Rhino-orbital-cerebral mucormycosis (ROCM), a rare but fatal fungal infection, has recently emerged as a serious complication after corticosteroids therapy in COVID-19 patients, predominantly in diabetic and immunocompromised patients. The World Health Organization (WHO) COVID-19 current guidelines recommend corticosteroids administration in hospitalized COVID-19 patients requiring supplementary oxygen or mechanical ventilation. Herein, we report a case series of seven patients with COVID-19; three mild, three moderate, and one severe, from Lahore, Pakistan; all were using corticosteroids for managing their early mild symptoms of COVID-19 at home for around 2-3 weeks without a physician's advise, presented, and admitted with ROCM to Mayo hospital, Lahore, from March to June 2021. Out of the seven patients, five patients had uncontrolled diabetes mellitus (DM) as comorbidity. Eye pain, facial swelling and pain, nasal blockage, and black coloration around eyes, on palate, and oral mucosa were the presenting complaints at the time of admission. All the patients had radiographic imaging, including computed tomography (CT), paranasal sinuses (PNS), or brain magnetic resonance imaging (MRI) carried out at the hospital, which confirmed mucosal thickening and adjacent sinus bony erosions with intracranial extension. All the patients were treated with local debridement of the infected necrotic tissue along with intravenous liposomal Amphotericin B and Posaconazole or Amphotericin B depending on the case. Due to timely management, in six out of seven patients, prognosis was good due to early diagnosis and treatment, while one patient with severe COVID-19 illness deteriorated and died. The misuse of corticosteroids for managing early mild symptoms of COVID-19 in diabetic and other immunocompromised patients can lead to fatal ROCM, which can further increase their risk of developing severe COVID-19 and mortality. It is stressed that only physician's recommended therapeutic advice should be followed for managing early mild symptoms of COVID-19 in self-isolation and avoid the unnecessary use of corticosteroids. This case series also emphasizes that COVID-19 diabetic patients treated with corticosteroids need more vigilant monitoring and high suspicion of early diagnosis and treatment of invasive fungal infection. Early diagnosis and management can reduce morbidity and mortality.
鼻眶脑型毛霉菌病（ROCM）是一种罕见但致命的真菌感染，最近已成为COVID-19患者在接受皮质类固醇治疗后出现的严重并发症，主要发生在糖尿病患者和免疫功能低下的患者中。世界卫生组织（WHO）的COVID-19现行指南建议，对于需要补充氧气或机械通气的住院COVID-19患者，应给予皮质类固醇治疗。在此，我们报告了一组来自巴基斯坦拉合尔的7例COVID-19患者的病例系列；其中3例为轻症，3例为中症，1例为重症；所有患者均在没有医生建议的情况下，在家自行使用皮质类固醇治疗COVID-19早期轻症症状约2至3周，随后于2021年3月至6月因ROCM就诊并入住拉合尔梅奥医院。在这7例患者中，有5例患者合并未控制的糖尿病（DM）。入院时的主要症状包括眼痛、面部肿胀和疼痛、鼻塞以及眼周、上腭和口腔黏膜出现黑色色素沉着。所有患者均在医院接受了影像学检查，包括计算机断层扫描（CT）、鼻窦（PNS）或脑部磁共振成像（MRI），检查结果证实存在黏膜增厚以及相邻鼻窦骨质侵蚀并伴有颅内扩展。所有患者均根据具体情况接受了感染坏死组织的局部清创治疗，并静脉注射脂质体两性霉素B和泊沙康唑或两性霉素B。由于治疗及时，7例患者中有6例因早期诊断和治疗，预后良好，而1例重症COVID-19患者病情恶化并死亡。在糖尿病患者和其他免疫功能低下的患者中，滥用皮质类固醇治疗COVID-19早期轻症症状可能导致致命的ROCM，这可能会进一步增加他们发展为重症COVID-19的风险和死亡率。需要强调的是，在自我隔离期间，对于COVID-19早期轻症症状的治疗，应仅遵循医生推荐的治疗建议，避免不必要地使用皮质类固醇。该病例系列还强调，接受皮质类固醇治疗的COVID-19糖尿病患者需要更密切的监测，并高度怀疑早期诊断和治疗侵袭性真菌感染。早期诊断和治疗可以降低发病率和死亡率。
