True Mycotic Aneurysms: A Report of Three Patients with Internal Carotid Artery Aneurysm and Mucormycosis, and Literature Review

Abstract

Background Aneurysm formation of internal carotid arteries (ICA) in patients with mucormycosis is a scarce phenomenon. However, the prevalence of rhino-cerebral mucormycosis has been reported to increase after the coronavirus disease 2019 (COVID-19) pandemic. Methods Three patients with stroke and subarachnoid hemorrhage due to ICA aneurysm after the involvement of adjacent paranasal sinuses with mucormycosis were presented. All patients were recruited from Namazi and Khalili hospitals affiliated with Shiraz University of Medical Sciences in Iran from April 2021 to May 2021. Results They had a history of diabetes and corticosteroid use. Also, one of them was treated with imatinib. Two out of three patients were infected with SARS-CoV-2 infection before developing mucormycosis. Two patients had diagnostic angiography before endovascular intervention. One patient did not undergo any therapeutic intervention due to total artery occlusion, whereas the other patient experienced a successful parent artery occlusion by coiling, and only this patient survived. Although all patients received antifungal treatment and surgical debridement, two of them died. Conclusions In the patients with rhino-cerebral mucormycosis evolving of aneurysm should be promptly and meticulously investigated by magnetic resonance angiography (MRA) and computed tomography angiography (CTA). As this type of aneurysms was very fast-growing, as soon as the involvement of sphenoid sinus was detected, the possibility of ICA aneurysm formation should always be kept in mind. If the patient developed an aneurysm, prompt intensive antifungal therapy and therapeutic endovascular interventions such as stenting, coiling, or sacrificing should be considered as soon as possible to optimize outcomes.

Conduction System Disease in Victims of COVID-19

“…In addition, the high incidence of S1Q3T3 and LBBB in this study could be an indicator of pulmonary involvement in COVID-19 victims. S1Q3T3 is a relatively specific pattern for pulmonary thromboembolism and a potential cause of death (21,(34)(35)(36)(37). Moreover, assessing ECG parameters in conduction system disease in victims of COVID-19, ST-T changes, fragmented QRS, axis deviation, presence of S1Q3T3, and poor R wave progression were significantly related to conduction disease in victims of COVID-19.…”

“…Second, SARS-CoV-2-induced myocardial injury due to upregulation of ACE2 receptor during the viral invasion and severe hypoxia-induced myocyte necrosis is another potential cause of arrhythmias (17). Besides, acute myocardial infarction due to demand/supply imbalance and arterial thrombotic event secondary to hypercoagulable state can cause acute arrhythmias (18)(19)(20)(21). In addition, Stress-induced cardiomyopathy owing to physiological stress and cytokine storm about sepsis and high inflammatory state is another potential mechanism triggering arrhythmias (15,(22)(23)(24).…”