Decoding “guitar pick sign” in COVID-19–associated mucormycosis: A case series

Reddy, Y Muralidhar; Parida, Subhendu; Reddy, Shivakumar; Yeduguri, Sreekanth; Pidaparthi, Lalitha; Jaiswal, Shyam K; Sadhvani, Bhavna; Murthy, J. M. K.

doi:10.4103/ijo.ijo_2598_21

Cited by 3 publications

(2 citation statements)

References 9 publications

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“…Reddy et al . [ 37 ] in a case series have beautifully described the posterior globe tenting as a “guitar pick sign”: an important radiological surrogate marker of tense orbit and profound vision loss in ROCM. Magnetic resonance angiography is an important tool to determine involvement of the cavernous sinus and the ischemic damage to the cerebral tissues, as demonstrated by Parsi et al .…”

Section: Investigationsmentioning

confidence: 99%

Rhino-orbito-cerebral mucormycosis and its resurgence during COVID-19 pandemic: A review

Karkhur

Soni

Chauhan

et al. 2022

Indian Journal of Ophthalmology

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This study aimed to review the current literature for epidemiology, pathogenesis, clinical spectrum and management of rhino-orbito-cerebral-mucormycosis (ROCM), especially highlighting the association between ROCM and COVID-19 disease and factors resulting in its resurgence during the pandemic. Mucormycosis is a rare, but an important emerging opportunistic fungal infection, often associated with high morbidity and mortality. ROCM is the commonest and also the most aggressive clinical form occurring in debilitated patients in conjunction with sinus or para-sinus involvement due to the propensity for contiguous spread. Recently ROCM has shown an unprecedented resurgence during the current pandemic. Reports from different parts of the world indicated an increased risk and incidence of ROCM in patients who had required hospital admission and have recovered from moderate-to-severe COVID-19 disease. A majority of mucormycosis cases have been reported from India. The presence of diabetes mellitus (DM) and use of corticosteroids for COVID-19 pneumonia were found to be the key risk factors, resulting in higher mortality. Amidst the ongoing pandemic, with the third wave already having affected most of the world, it becomes imperative to adopt a risk-based approach toward COVID-19 patients predisposed to developing ROCM. This could be based on the most recently published literature and emerging data from centers across the world. The present review intended to elucidate the causes that brought about the current spike in ROCM and the importance of its early detection and management to reduce mortality, loss of eye, and the need for mutilating debridement.

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Section: Investigationsmentioning

confidence: 99%

Rhino-orbito-cerebral mucormycosis and its resurgence during COVID-19 pandemic: A review

Karkhur

Soni

Chauhan

et al. 2022

Indian Journal of Ophthalmology

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“…Posterior globe tenting is known as the “guitar pick sign” due to raised intraocular pressure caused by intraorbital inflammation, swelling of extraocular muscles, retro-orbital fat stranding, and focal collection. This sign is also present in other inflammatory conditions and traumatic retrobulbar hemorrhage [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

A Retrospective Study of Imaging of Invasive Rhino-Orbital-Cerebral Mucormycosis in the COVID-19 Pandemic in a Tertiary Care Center

Ranjan,

Kumar,

Sinha

et al. 2024

Cureus

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Aim The study aims to analyze the imaging findings of invasive rhino-orbital-cerebral mucormycosis (ROCM) in patients who had COVID-19. Materials and methods This retrospective descriptive study was done on confirmed (culture and histopathology) patients who had a COVID-19 infection. The data was collected from the record section from May 2021 to June 2021. Imaging data were analyzed, and findings were tabulated according to statistical methods. Results Radiological evaluation, including CT and MRI, was done in 48 cases. The ethmoid sinus was the most common sinus involved in 60.41% of cases, followed by the maxillary sinus (52.09%). Unilateral pansinusitis was observed in 21 cases (43.75%). Among periantral extensions, retroantral fat involvement was the most common finding, seen in 24 cases (50%). Lamina papyracea and the walls of the maxillary sinus were involved in eight cases (16.67%). A total of 38 cases (79.17%) exhibited involvement of the extraconal compartment, while 32 cases (66.67%) showed involvement of the intraconal compartment. In intracranial involvement, infarct was noted in 13 cases (27%), and cavernous sinus involvement in nine cases (18.75%). Conclusions ROCM is a life-threatening fungal infection in immunocompromised patients, especially diabetics. Imaging of ROCM plays a pivotal role in early diagnosis, the extent of disease, surgical planning, prognosis, and the response to treatment. Radiologists must know the imaging features and patterns of extension of ROCM.

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Clinical Phenotypes of COVID-19 Associated Mucormycosis (CAM): A Comprehensive Review

et al. 2022

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A mucormycosis surge was reported during the COVID-19 pandemic in India. A literature search until 14 July 2022, with the aim of updating COVID-19-associated mucormycosis (CAM), identified 663 studies and 88 met inclusion criteria (8727 patients). India reported 8388 patients, Egypt 208 and Europe 40. Rhino-orbito-cerebral mucormycosis (ROCM) was identified among 8082 (98.3%) patients, followed by 98 (1.2%) with pulmonary. In India, 82.6% of patients had diabetes mellitus, with 82% receiving corticosteroids. In Europe, 75% presented pulmonary CAM, 32.5% had diabetes and 40% were immunocompromised. CAM was identified at a median of 17.4 days (IQR 7.5 days) post COVID-19 diagnosis, and PCR was performed in five studies. Rhino-orbital invasion is clinically obvious, while cerebral involvement presents with cavernous sinus thrombosis, meningitis and cerebrovascular disease. Symptoms of pulmonary CAM usually overlap with severe COVID-19 pneumonia. High-dose liposomal Amphotericin B (and early surgical debridement in ROCM) are the mainstay of therapy. The median mortality rate was estimated to be 21.4% (IQR 31.9%), increased by the presence of pulmonary (80% (IQR 50%) or cerebral involvement (50% (IQR 63.9%). In summary, different CAM clinical phenotypes need to be distinguished, influenced by geographical presentation. Opportunities exist for diagnosis and therapy optimization, based on earlier high-dose antifungal therapy, early source control, strict glycemic control and restriction of steroids to COVID-19 patients with oxygen requirements.

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Decoding “guitar pick sign” in COVID-19–associated mucormycosis: A case series

Cited by 3 publications

References 9 publications

Rhino-orbito-cerebral mucormycosis and its resurgence during COVID-19 pandemic: A review

Rhino-orbito-cerebral mucormycosis and its resurgence during COVID-19 pandemic: A review

A Retrospective Study of Imaging of Invasive Rhino-Orbital-Cerebral Mucormycosis in the COVID-19 Pandemic in a Tertiary Care Center

Clinical Phenotypes of COVID-19 Associated Mucormycosis (CAM): A Comprehensive Review

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