Mucormycosis in a Patient With AIDS Receiving Systemic Steroids

Abstract

Mucormycosis is an opportunistic fungal infection with a high mortality rate. Although mucormycosis is relatively rare, recent studies suggest that the incidence is on the rise as a result of increased use of chemotherapy and steroids. The authors present an unusual case of invasive mucormycosis in a hospitalized patient with AIDS who was receiving short-term, high-dose steroids and who had associated steroid-induced diabetes. The patient was otherwise healthy, with no underlying risk factors such as neutropenia or intravenous drug use. The patient developed acute onset of proptosis, vision loss, and invasive Mucor in the left maxillary sinus that extended along the optic nerve intracranially. Despite aggressive treatment, the patient died. Physicians should be aware of steroid-induced diabetes as a risk factor for invasive fungal infections such as mucormycosis.

Rhino-orbital mucormycosis following COVID-19 in previously non-diabetic, immunocompetent patients

“…24 Also, cases of mucormycosis that received corticosteroids during COVID-19 treatment are shown to be associated with poorer outcomes. 25 Sen et al reported that in their series of patients of ROCM, 98% of the patients who developed ROCM showing complete ptosis of the left eye. Magnetic resonance imaging with contrast was performed which showed diffuse intraconal fat stranding, optic nerve enhancement and ill-defined soft tissue lesion at the orbit in (B).…”

Rhino-orbito-cerebral mucormycosis during the COVID-19 third wave in 2021: an Egyptian preliminary report from a single tertiary hospital

“…Undoubtedly, the rush use of glucocorticoids in patients with COVID-19 has contributed to the outbreaks of COVID-19-associated mucormycosis [ 6 , 40 ]. Glucocorticoid-induced immunosuppression, hyperglycemia, and lymphopenia predispose to the pathogenesis of mucormycosis [ 33 ].…”

COVID-19 Associated Rhino-Orbital Mucormycosis Complicated by Gangrenous and Bone Necrosis—A Case Report from Honduras

“…For these reasons, when suspecting mucormycosis, it is important to assess by appropriate CNS imaging ( Figure 2 and Figure 3 ). Nowadays, in context of the COVID-19 pandemic, prevalent risk factors, such as diabetes, especially decompensated [ 4 , 5 , 6 , 8 , 17 , 20 ], and most importantly the inappropriate use of steroids, has led to an increase of cases similar to the one presented herein [ 15 ]. For those patients with known risk factors such as diabetes, malignancies (particularly haematological), steroid use, neutropenia, HIV/AIDS, and immunosuppression in general, mucormycosis should always be considered in the differential diagnosis, in order to deliver prompt treatment [ 1 , 15 ].…”

“…Mucormycosis is also an important emerging condition among patients with haematological malignancies, allogeneic stem cell transplantation, and diabetes mellitus [ 4 ]. Historically, the inappropriate use of steroids has been linked with the development of this invasive fungal infection [ 5 , 6 ], particularly if associated with any of the abovementioned risk factors [ 7 , 8 ]. Moreover, inappropriate steroid use may trigger concurrent invasive fungal infections, such as concomitant mucormycosis and aspergillosis [ 9 ].…”