Awan Bakhtawar, Elsaigh Mohamed, Tariq Areej
General and Emergency Surgery Department, Northwick Park Hospital, London, GBR.
General and Emergency Surgery Department, Royal Cornwall Hospitals NHS Trust, Truro, GBR.
Cureus. 2024 Nov 30;16(11):e74852. doi: 10.7759/cureus.74852. eCollection 2024 Nov.
Mucormycosis is a rare but potentially fatal angioinvasive fungal infection, caused by filamentous molds of the order Mucorales, which primarily affects immunocompromised individuals and is characterized by high mortality rates. Diabetes mellitus (DM) is the most common risk factor for mucormycosis. During the COVID-19 pandemic, the number of cases significantly increased. Mucormycosis may present in several clinical forms, but the most common form is the rhinocerebral form. This case report aims to emphasize the severity of mucormycosis in a patient with uncontrolled DM who recently recovered from COVID-19. Furthermore, this study demonstrates the importance of early diagnosis and proper treatment to prevent fatal progression. A 58-year-old man is presented in our case report; the patient was recently diagnosed with DM and presented to the outpatient department (OPD) with complaints of right eye ptosis and progressively worsening painful vision loss over 10 days. He had been infected with SARS-CoV-2 infection 15 days earlier and was treated at home with systemic corticosteroids and antibiotics. One week after recovery, he experienced spontaneous nasal bleeding, followed by progressive ocular symptoms that culminated in restricted eye movement and complete vision loss in the right eye. Physical examination revealed right eye proptosis and no light perception. Laboratory tests indicated an elevated C-reactive protein (CRP) level of 25.65 mg/dL and a significantly high glycated hemoglobin A1c (HbA1c) level of 16.3%. A tissue biopsy showed inflammatory nasal polyps associated with mucormycosis. The patient was promptly treated with insulin in order to control the elevated HbA1c and amphotericin B to stop the fungal infection and underwent extensive surgical excision. Our case highlights the severity of mucormycosis in a patient with uncontrolled DM who recently recovered from COVID-19 and shedding light on the importance of controlling the DM in order to reduce the negative impacts on the patient's health. The patient underwent proper treatment with antifungals and aggressive surgical excision to prevent more invasion of the fungi. Despite that, neurological deficits persist including complete loss of vision in one eye which reflects the importance of early diagnosis and proper management to prevent fatal progression.
毛霉病是一种罕见但可能致命的血管侵袭性真菌感染，由毛霉目丝状霉菌引起，主要影响免疫功能低下的个体，其特点是死亡率高。糖尿病（DM）是毛霉病最常见的危险因素。在新冠疫情期间，病例数显著增加。毛霉病可能有几种临床形式，但最常见的形式是鼻脑型。本病例报告旨在强调一名近期从新冠中康复的糖尿病控制不佳患者中毛霉病的严重性。此外，本研究证明了早期诊断和适当治疗以防止致命进展的重要性。我们的病例报告介绍了一名58岁男性；该患者最近被诊断出患有糖尿病，因右眼上睑下垂和10天来逐渐加重的疼痛性视力丧失前往门诊就诊。他15天前感染了新冠病毒，并在家中接受了全身性皮质类固醇和抗生素治疗。康复一周后，他出现自发性鼻出血，随后出现进行性眼部症状，最终导致眼球运动受限和右眼完全失明。体格检查发现右眼突出且无光感。实验室检查显示C反应蛋白（CRP）水平升高至25.65mg/dL，糖化血红蛋白A1c（HbA1c）水平显著升高至16.3%。组织活检显示炎性鼻息肉伴毛霉病。患者立即接受胰岛素治疗以控制升高的HbA1c，并使用两性霉素B来阻止真菌感染，还接受了广泛的手术切除。我们的病例突出了一名近期从新冠中康复的糖尿病控制不佳患者中毛霉病的严重性，并揭示了控制糖尿病以减少对患者健康负面影响的重要性。患者接受了抗真菌药物的适当治疗和积极的手术切除以防止真菌进一步侵袭。尽管如此，神经功能缺损仍然存在，包括一只眼睛完全失明，这反映了早期诊断和适当管理以防止致命进展的重要性。
