Rhinocerebral Mucormycosis With Brain Abscess Presenting as Status Epileptucus in a COVID-19-Infected Male: A Calamitous Complication

Verma, Vinay Kumar; Acharya, Sourya; Kumar, Sunil; Gaidhane, Shilpa; Thatere, Utkarsh

doi:10.7759/cureus.21061

Cited by 4 publications

(3 citation statements)

References 11 publications

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“…Acute frontal sinusitis can lead to orbital or bony complications. It could be of bacterial or fungal etiology [10][11][12]. Frontal osteomyelitis has been reported following both acute and chronic bacterial frontal sinusitis [13].…”

Section: Discussionmentioning

confidence: 99%

Osteomyelitis of Frontal Sinus: A Rare Sequelae of Acute Bacterial Sinusitis Associated With Anatomical Variations in the Frontal Sinus Drainage Pathway

Wadhwa,

Jain,

Gupta

et al. 2024

Cureus

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Frontal osteomyelitis is characterized by localized osteal inflammation of the frontal bone. This is a rare complication of acute frontal sinusitis. The present case is being reported to highlight the likely role of anatomical variations in frontal sinus drainage pathways in the causation of this complication apart from other known predisposing factors like young age and immunocompromised state. The patient initially presented with seizures, fever, and headache and was diagnosed with viral encephalitis. However, the symptoms gradually progressed to cause right eye swelling and an increase in the severity of headache without any nasal complaints. Diagnostic nasal endoscopy revealed mucopurulent secretions in both nasal cavities. Computed tomography and magnetic resonance imaging diagnosed the anatomical variations, the extent of sinus involvement, and frontal osteomyelitis. Antimicrobial therapy for an extended duration of four weeks, along with functional endoscopic sinus surgery resulted in excellent outcomes.

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Section: Discussionmentioning

confidence: 99%

Osteomyelitis of Frontal Sinus: A Rare Sequelae of Acute Bacterial Sinusitis Associated With Anatomical Variations in the Frontal Sinus Drainage Pathway

Wadhwa,

Jain,

Gupta

et al. 2024

Cureus

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“…Hyperglycemia, acidosis, and elevated free serum iron cause overexpression of GRP-78 receptor on endothelial cells of blood vessels and facilitate angioinvasion by interaction with CotH3 protein on fungal hyphae. [6,10,14,25] COVID-19 virus further enhances this diabetogenic state by acting on angiotensin-converting enzyme 2 receptors in islet cells of the pancreas. [10] Mucor produces an enzyme, ketoreductase which functions in a hyperglycemic state and enables them to grow and spread in an acidic environment.…”

Section: Discussionmentioning

confidence: 99%

“…It must be continued until a favorable clinical response and resolution of the radiological feature of active infection is obtained, which may take a few weeks, after which oral posaconazole (300 mg twice a day for 1 day followed by 300 mg daily) or isavuconazole (200 mg thrice daily for 2 days followed by 200 mg daily) can be started. [25] e liposomal form is preferred because it is less nephrotoxic and thus allows for higher doses to be given for a longer period. Secondline treatment includes intravenous posaconazole, which can be tried as salvage therapy in patients with impaired renal function or if amphotericin-based treatment fails.…”

Section: Discussionmentioning

confidence: 99%

Surgical management of post-COVID invasive rhino-orbito-cerebral mucormycosis and its outcomes: Role of neurosurgeons in a tertiary care center

Das¹,

Mani²,

Singh³

2022

Surgical Neurology International

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Background: Mucormycosis, which was previously considered to be rare, has emerged with a new challenge in patients infected with or recovering from COVID-19. Immunocompromised patients are particularly prone to developing this disease. The most common form of presentation is rhino-orbito-cerebral mucormycosis (ROCM). We present various neurosurgical approaches to an entire spectrum of its clinical manifestations. Methods: This is a retrospective study of patients who were admitted to the neurosurgery department with ROCM and a history of COVID-19 infection between November 1, 2020, and September 1, 2021. All cases of ROCM underwent contrast-enhanced computed tomography/magnetic resonance imaging of the brain, paranasal sinuses, and orbit. A tissue biopsy was sent for histopathological analysis. All confirmed cases received liposomal amphotericin B and surgical treatment was immediately undertaken. Results: Out of 200 patients with ROCM, 40 patients presented with neurological manifestations. Seven out of 40 patients had focal lesions in the brain and skull bone that needed neurosurgical intervention along with sinus debridement and antifungal treatment. These seven patients presented with different clinical manifestations: large-vessel stroke (one), medium-vessel stroke (one), frontal lobe abscess (one), frontal bone osteomyelitis (two), isolated central nervous system involvement (one), and mucor mimicking trigeminal schwannoma (one). The surgical intervention included decompressive craniectomy, frontal craniotomy, subtemporal craniotomy, and a minimally invasive supraorbital keyhole approach. Conclusion: In high-risk patients, a high level of clinical suspicion combined with appropriate investigations should be performed as soon as possible. Symptoms and early warning signs should not be overlooked, as treatment delays can be fatal. A minimally invasive surgical approach is possible in view of decreasing the morbidity of large craniotomy.

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Comparative risk assessment of COVID‐19 associated mucormycosis and aspergillosis: A systematic review

Baral

Aziz

Islam

2022

Health Science Reports

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COVID‐19 is not only limited to a defined array but also has expanded with several secondary infections. Two uncommon opportunistic fungal infections, COVID‐19 associated mucormycosis (CAM) and aspergillosis (CAA), have recently been highly acquainted by many worldwide cases. Two immune response deteriorating factors are considered to be responsible for immunosuppression: comorbidities and medication. Due to unlike infection sites and patterns, CAM and CAA‐associated factors deflect a few degrees of proximity, and the present study is for its assessment. The study evaluated 351 CAM cases and 191 CAA cases retrieved from 65 and 53 articles based on inclusion criteria, respectively. Most of the CAM reported from India and CAA were from four South‐European and West‐European neighbor countries. The mean ages of CAM and CAA were 52.72 ± 13.74 and 64.81 ± 11.14, correspondingly. Mortality of CAA (56.28%) was two times greater than CAM (26.02%). Nevertheless, the count of diabetes cases was very high in CAM compared to CAA. The main comorbidities of CAM were diabetes (nearly 80%) and hypertension (more than 38%). All noticeable complications were higher in CAA except diabetes, and these were diabetes (34.55%), hypertension (45.03%), and obesity (18.32%). Moreover, pre‐existing respiratory complications like asthma and chronic obstructive pulmonary disease are visible in CAA. The uses of steroids in CAM and CAA were nearly 70% and 66%, respectively. Almost one‐fourth of CAA cases were reported using immunosuppressant monoclonal antibodies, whereas only 7.69% were for CAM. The overall finding highlights diabetes, hypertension, and steroids as the risk factors for CAM, whereas obesity, chronic pulmonary disease, and immunosuppressants for CAA.

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Rhinocerebral Mucormycosis With Brain Abscess Presenting as Status Epileptucus in a COVID-19-Infected Male: A Calamitous Complication

Cited by 4 publications

References 11 publications

Osteomyelitis of Frontal Sinus: A Rare Sequelae of Acute Bacterial Sinusitis Associated With Anatomical Variations in the Frontal Sinus Drainage Pathway

Osteomyelitis of Frontal Sinus: A Rare Sequelae of Acute Bacterial Sinusitis Associated With Anatomical Variations in the Frontal Sinus Drainage Pathway

Surgical management of post-COVID invasive rhino-orbito-cerebral mucormycosis and its outcomes: Role of neurosurgeons in a tertiary care center

Comparative risk assessment of COVID‐19 associated mucormycosis and aspergillosis: A systematic review

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