Narra Ramakrishna, Rayapati Shravya
Department of Radiodiagnosis, Katuri Medical College, Guntur, Andhra Pradesh 522018, India.
World J Radiol. 2023 Jul 28;15(7):234-240. doi: 10.4329/wjr.v15.i7.234.
Rhinocerebral mucormycosis (RCM) is a rare, fatal, invasive fungal infection infecting mainly patients with immunocompromised conditions, such as diabetes mellitus, hematologic malignancies, and organ transplantations. Coronavirus disease 2019 (COVID-19) disease in these patients further weakens the immune system due to several factors, including hypoxia, corticosteroid usage (further increasing hyperglycemic status), mechanical ventilation, increased serum ferritin levels, endothelitis due to free radicals, and glucose receptor protein upregulation. Timely diagnosis, judicious treatment decisions, and diabetes control with proper treatment guidelines in patients with coexisting COVID-19 disease can reduce complication rates and improve survival.
A 75-year-old male patient with diabetes and hypertension diagnosed with COVID-19 presented to the emergency department. Laboratory examinations revealed elevated blood glucose levels, as well as ketone bodies in the urine. He was treated with oxygen and steroids, as well as insulin to correct blood glucose levels. He complained of a headache 10 d later, and imaging demonstrated mucosal thickening in bilateral sphenoidal, ethmoidal, and maxillary sinuses with hyperdense foci in the right maxillary sinus but without central nervous system involvement. Surgical debridement was performed, and a histopathological study revealed fungi hyphae. Systemic antifungals (amphotericin b and posaconazole) were administered. Subsequently, on 15 day he developed right lower limb weakness and left lateral rectus palsy. There was slow but steady progress, and he was discharged. However, he presented to emergency department 1mo later with altered sensorium and poor control of diabetes resulted in an intracranial spread of mucormycosis, which ultimately led to the patient's poor prognosis and slow recovery.
Prompt early diagnosis, judicious treatment decisions, and diabetes control with proper treatment guidelines are necessary in patients with COVID-19 associated invasive RCM to reduce complication rates and improve patient survival.
鼻脑型毛霉菌病（RCM）是一种罕见的、致命的侵袭性真菌感染，主要感染免疫功能低下的患者，如糖尿病患者、血液系统恶性肿瘤患者和器官移植患者。由于多种因素，包括缺氧、使用皮质类固醇（进一步加重高血糖状态）、机械通气、血清铁蛋白水平升高、自由基导致的血管内皮炎症以及葡萄糖受体蛋白上调，2019冠状病毒病（COVID-19）会使这些患者的免疫系统进一步受损。对于合并COVID-19的患者，及时诊断、明智的治疗决策以及遵循适当的治疗指南控制糖尿病，可降低并发症发生率并提高生存率。
一名75岁患有糖尿病和高血压且确诊为COVID-19的男性患者被送往急诊科。实验室检查显示血糖水平升高，尿中出现酮体。给予其吸氧、类固醇以及胰岛素治疗以纠正血糖水平。10天后，他主诉头痛，影像学检查显示双侧蝶窦、筛窦和上颌窦黏膜增厚，右侧上颌窦有高密度灶，但未累及中枢神经系统。进行了手术清创，组织病理学研究发现真菌菌丝。给予全身性抗真菌药物（两性霉素B和泊沙康唑）治疗。随后，在第15天，他出现右下肢无力和左侧外直肌麻痹。病情进展缓慢但稳定，之后出院。然而，1个月后他因意识改变再次就诊于急诊科，糖尿病控制不佳导致毛霉菌病颅内播散，最终导致患者预后不良且恢复缓慢。
对于合并COVID-19相关侵袭性RCM的患者，早期及时诊断、明智的治疗决策以及遵循适当的治疗指南控制糖尿病，对于降低并发症发生率和提高患者生存率是必要的。
