Rhino-orbital Mucormycosis in a COVID-19 Patient: The First Case in Malaysia

Temporomandibular joint ankylosis is caused by trauma, infection, autoimmune, inflammatory joint diseases, and several other minor causes. Mucormycosis causing temporomandibular joint ankylosis has not been reported. We report two cases of temporomandibular joint ankylosis caused by mucormycosis from 2018 to 2022. In both cases, the infection started in the maxilla, then progressed to orbit. After that, involvement of the mastoid process, styloid process, and base of the skull was observed in the first case, while in the second case, there was the involvement of the base of the skull and mandibular ramus. As the temporomandibular joint (TMJ) components are contiguous to the base of the skull, it got affected causing temporomandibular joint ankylosis. Mucormycosis was diagnosed by KOH mount. The smear examination showed aseptate hyphae at 90 0 . Histopathology examination further confirmed mucormycosis. Glycemic control was done by infusing Insulin (both Lantus and regular). The case was managed with aggressive debridement and interpositional arthroplasty with a buccal fat pad. Liposomal amphotericin infusion was also started pre-operatively and continued in the post-operative phase. After 4 years of follow-up, the patient is well and had adequate mouth opening.Mucormycosis infection affecting the TMJ has been reported in the literature. However, this is the first report of a mucormycosis infection resulting in TMJ ankylosis in the literature. The infection should be aggressively managed. Reversals of an immunocompromised state, aggressive surgical management, and antifungal medication are the key factors for the success of the deadly fungal infection.

Section: Discussionmentioning

confidence: 99%

Rhino-Orbital Cerebral Mucormycosis Causing Temporomandibular Joint Ankylosis: A Case Series of Two Patients

Mokhtar¹,

Fatima²,

Akbar³

et al. 2023

“…These include diabetes mellitus, hematological malignancies, and bone marrow or solid organ transplantation [ 1 ]. A case report of rhino-orbital mucormycosis in a COVID-19 patient was previously reported in Malaysia [ 5 ]. Additionally, the use of deferoxamine chelation therapy can increase the risk of infection, as Rhizopus sp.…”

Section: Discussionmentioning

confidence: 99%

“…The infection can spread to adjacent sinuses, orbit, and cranium. Based on the site of infection, mucormycosis is classified into six major forms: rhino-cerebral, pulmonary, cutaneous, gastrointestinal, disseminated, and uncommon rare forms such as endocarditis, osteomyelitis, peritonitis, and renal infection [ 2 , 5 ].…”

Section: Discussionmentioning

confidence: 99%

Successful Treatment of Mucormycosis Caused by Rhizopus arrhizus With Amphotericin B and Itraconazole

Cham¹,

Radhakrishnan²,

Chang³

2023

Self Cite

Mucormycosis is a serious and often fatal fungal infection that is most commonly observed in immunocompromised individuals. The mortality rate of mucormycosis is high if left untreated, and successful treatment requires a combination of antifungal therapy, surgical intervention, and reversal of the underlying immunocompromised state. The choice of antifungal treatment is crucial and depends on several factors, including the safety profile of the drug, its spectrum of activity, and the species of fungus causing the infection. In this report, we describe a case of a patient who presented with mucormycosis and was successfully treated with a combination of antifungal therapy, surgical excision of affected tissue, and reversal of the underlying immunocompromised state. Our report underscores the importance of early recognition and aggressive treatment of mucormycosis to improve outcomes for affected patients.

“…The diagnosis of mucormycosis is challenging if indicators such as thrombosis and necrotic tissue are absent or are late in presentation [ 9 ]. The major risk factors associated with this infection include diabetes, corticosteroid therapy, hematological and solid organ malignancies, transplant recipients, and neutropenia [ 10 ]. The risk factors associated with healthcare outbreaks include prolonged oxygen support, poor air filtration, and non-sterile medical instruments [ 5 , 7 ].…”

Section: Discussionmentioning

confidence: 99%

Presumptive Rhino-Orbital Mucormycosis Secondary to Corticosteroid Therapy in a Diabetic Patient With COVID-19 Infection

Sidhu¹,

Hitam²,

Tajudin³

2023

The coronavirus disease 2019 pandemic has led to the widespread use of steroids as a life-saving measure. In patients with preexisting diabetes, the therapeutic use of steroids coupled with poorly controlled sugar has led to a surge of mucormycosis. We report a rare case of orbital apex syndrome secondary to mucormycosis post-COVID-19. A 43-year-old female with poorly controlled diabetes mellitus presented with right eye complete ptosis one week post-recovery from COVID-19 infection. During COVID-19 hospitalization, she received a course of dexamethasone. The visual acuity of the right eye was 6/60. She had complete ophthalmoplegia and diplopia in all gazes. There was a positive relative afferent pupillary defect (RAPD) and reduced optic nerve function test in the right eye. MRI showed right ethmoid sinusitis with possible extension to the right orbit and the presence of right perineural optic nerve enhancement. The nasal scope revealed fungal-like thick mucopurulent discharge at the middle meatus. She was clinically diagnosed with rhino-orbital mucormycosis and was started on antifungal for six weeks. Her overall condition improved with 6/6 visual acuity and minimum residual ophthalmoplegia. In conclusion, corticosteroid treatment for COVID-19 infection in diabetic patients causes poor glycemic control and immunosuppression that can lead to secondary infections such as rhino-orbital mucormycosis.