Rhino-Orbito-Cerebral Mucormycosis in Diabetic Disease Mucormycosis in Diabetic Disease

Abstract

The authors present their experience about clinical evidences that include patients with an untreated diabetes who developed rhino-orbito-cerebral mucormycosis (ROCM). They were treated with endoscopic sinus surgery and medical treatment with intravenous, intradural therapy, and sinus washes with amphotericin B. The ROCM is a disease with a rapid evolution and an increase in mortality rate, especially if the fungus enters the cranial cavity. Therefore, it would be necessary in all diabetic patients with sinus symptoms, headaches, visual changes, suspect a mucormycosis, and perform a careful radiology assessment and a nasal endoscopy. Often, despite an early diagnosis and rapid treatment for ROCM, it is not possible to stem the disease, which ends with the patient's death.

Optical Coherence Tomography Predictors of Favorable Functional Response in Naïve Diabetic Macular Edema Eyes Treated with Dexamethasone Implants as a First-Line Agent

“…Recent studies have demonstrated the primary role of inflammatory and vascular factors in the pathogenesis and development of DME; however, these mechanisms are complex and still not completely clarified [ 2 – 4 ]. The neurovascular unit consists of Müller cells, astrocytes, ganglion cells, and amacrine cells in a dynamic interaction with retinal vascular endothelial cells and pericyte-releasing factors that induce the formation of tight junctions in retinal vessels [ 13 – 15 ]. Abnormalities in Müller cells probably affect this barrier property in the retinal vessels in diabetic patients [ 13 , 14 ].…”

“…Indeed, blood-retinal barrier disruption is associated with an increase of vascular endothelial growth factor (VEGF), intercellular adhesion molecule-1 (ICAM-1), interleukin-6 (IL-6), and monocyte chemotactic protein-1 (MCP-1) among others [14,16]. Furthermore, in the recent years, numerous advances have been made in the treatment of diabetic retinopathy and DME [14][15][16][17]. Anti-VEGF is considered first-line treatment; however, corticosteroids represent a fundamental alternative for treating these patients [10,18].…”

Rhino-orbito-cerebral mucormycosis causing cranial nerve abscess in post-COVID-19 status

“…Mucormycosis proved to be the lethal disease in untreated patients with diabetes or patients on immunosuppressive therapy with the same pattern of spread and severity. 1 2 Rhino-orbito-cerebral mucormycosis has been declared endemic by the Indian government recently. Due to the aggressive pattern of spreading in this disease, it rapidly involves the surrounding structures.…”

“…MRI stands to be the best diagnostic and non-invasive imaging technology that produces three-dimensional detailed anatomical images that help determine disease spreading with treatment. 1 This article highlights the role of MRI in the diagnosis of perineural complications observed in rhino-orbito-cerebral mucormycosis.…”

“…There are very few documented cases available in the literature describing the perineural spread of fungal infection, especially after this COVID-19 era; however, similar cases have been reported previously in patients with uncontrolled diabetes by Galletti et al . 1 A surgical biopsy from the inferior turbinate was done, which revealed non-septate fungal hyphae. Both the patients managed with antifungal drugs; however, they did not improve much.…”