Department of Ophthalmology, Vardhman Mahavir Medical College and Safdarjung Hospital, Near AIIMS, Ansari Nagar West, 110029, Delhi, India.
, New Delhi, India.
BMC Ophthalmol. 2022 Oct 1;22(1):389. doi: 10.1186/s12886-022-02611-8.
Mucormycosis is a potentially lethal, angioinvasive fungal infection caused by the Mucoracea family comprising Mucor, Rhizopus, and Absidia species. It is commonly associated with uncontrolled diabetes mellitus, the use of corticosteroids, immunosuppressive drugs, and Covid-19 infection. The occurrence of mucormycosis in an immunocompetent patient is rare. Also, only a few case reports have been published where patients developed mucormycosis with associated malarial infection.
A young female presented with a 3-weeks history of painful swelling and outward protrusion of the right eye with complete loss of vision. She had a history of P.vivax malaria two weeks before her ocular symptoms. On ocular examination, there was proptosis and total ophthalmoplegia with loss of corneal sensations in the right eye. Hematological examination revealed normocytic normochromic anemia and thrombocytopenia. MRI was suggestive of right-sided pansinusitis and orbital cellulitis with right superior ophthalmic vein thrombosis and bulky cavernous sinus. Nasal biopsy was negative for fungal culture. An emergency surgical debridement of all the sinuses was done with right orbital exenteration. Histopathology confirmed the diagnosis of mucormycosis and the patient improved post-operatively on systemic antifungals.
Such an association of mucormycosis with malaria infection is rarely reported in the literature and is hypothesized to be a result of immunosuppression caused by malaria. Also, emphasis is laid upon having a high index of suspicion for fungal infection in the setting of pansinusitis even if the risk factors are absent. We hereby report a case of rhino-orbital mucormycosis following P.vivax malaria in a 20-year-old female with anemia and thrombocytopenia.
毛霉菌病是一种潜在致命的血管侵袭性真菌感染，由毛霉科的毛霉属、根霉属和犁头霉属引起。它通常与未控制的糖尿病、皮质类固醇、免疫抑制药物和 COVID-19 感染有关。免疫功能正常的患者发生毛霉菌病很少见。此外，仅有少数病例报告发表，患者在患有疟疾感染的同时发生毛霉菌病。
一名年轻女性因右眼疼痛肿胀和向外突出，视力完全丧失，出现 3 周病史。她在眼部症状出现前两周患有间日疟原虫疟疾。眼部检查显示右眼突出和完全眼肌瘫痪，角膜感觉丧失。血液检查显示正细胞正色素性贫血和血小板减少症。MRI 提示右侧全鼻窦炎和眶蜂窝织炎，伴有右眼上直肌静脉血栓形成和海绵窦肿大。鼻活检真菌培养阴性。所有鼻窦均行紧急手术清创术，同时行右眼眶内容剜除术。组织病理学证实为毛霉菌病，患者术后在全身抗真菌治疗下病情改善。
这种毛霉菌病与疟疾感染的关联在文献中很少见，据推测是疟疾引起的免疫抑制所致。此外，即使没有危险因素，在全鼻窦炎的情况下，也要高度怀疑真菌感染。我们在此报告一例贫血和血小板减少症的 20 岁女性在感染间日疟原虫后发生的鼻-眶毛霉菌病。
