Unnecessary Use of Corticosteroids for managing early mild symptoms of COVID-19 may lead to Rhino-ortibal-cerebral mucormycosis in Patients with Diabetes – a case series from Lahore, Pakistan

Abstract

Rhino-orbital-cerebral mucormycosis (ROCM), a rare but fatal fungal infection, has recently emerged as a serious complication after corticosteroids therapy in COVID-19 patients, predominantly in diabetic and immunocompromised patients. The World Health Organization (WHO) COVID-19 current guidelines recommend corticosteroids administration in hospitalized COVID-19 patients requiring supplementary oxygen or mechanical ventilation. Herein, we report a case series of seven patients with COVID-19; three mild, three moderate, and one severe, from Lahore, Pakistan; all were using corticosteroids for managing their early mild symptoms of COVID-19 at home for around 2–3 weeks without a physician’s advise, presented, and admitted with ROCM to Mayo hospital, Lahore, from March to June 2021. Out of the seven patients, five patients had uncontrolled diabetes mellitus (DM) as comorbidity. Eye pain, facial swelling and pain, nasal blockage, and black coloration around eyes, on palate, and oral mucosa were the presenting complaints at the time of admission. All the patients had radiographic imaging, including computed tomography (CT), paranasal sinuses (PNS), or brain magnetic resonance imaging (MRI) carried out at the hospital, which confirmed mucosal thickening and adjacent sinus bony erosions with intracranial extension. All the patients were treated with local debridement of the infected necrotic tissue along with intravenous liposomal Amphotericin B and Posaconazole or Amphotericin B depending on the case. Due to timely management, in six out of seven patients, prognosis was good due to early diagnosis and treatment, while one patient with severe COVID-19 illness deteriorated and died. The misuse of corticosteroids for managing early mild symptoms of COVID-19 in diabetic and other immunocompromised patients can lead to fatal ROCM, which can further increase their risk of developing severe COVID-19 and mortality. It is stressed that only physician’s recommended therapeutic advice should be followed for managing early mild symptoms of COVID-19 in self-isolation and avoid the unnecessary use of corticosteroids. This case series also emphasizes that COVID-19 diabetic patients treated with corticosteroids need more vigilant monitoring and high suspicion of early diagnosis and treatment of invasive fungal infection. Early diagnosis and management can reduce morbidity and mortality.

COVID-19 Associated Mucormycosis and Risk Factors: A Case-Control Study from Turkey

“…2024; 17(4): e146817. diabetes and high steroid treatment (14,15). In our study, diabetes was a risk factor on its own.…”

A case series on isolated maxillary sinus involvement in mucormycosis

“…9,10 Patients usually have an associated immune compromised state such as diabetes mellitus, hematological malignancies, and post-transplant patients; 11,12 moreover, after the COVID pandemic, there was an enormous rise in the number of cases of this otherwise rare disease. 13,14 Since isolated involvement of maxillary sinus is an early stage in the course of the disease the patients usually present with mild non-specific symptoms such as nasal discharge, nasal obstruction, and facial pain which usually leads to clinical suspicion of rhinosinusitis. 15 Thus, performing diagnostic nasal endoscopy in these patients is of utmost importance as it characteristically shows areas of necrosis and secretions in the middle meatus (Figure 5).…”

Uso De Corticóides Em Cirurgias Orais Menores

“…Pacientes com comorbidades, como diabetes, necessitam de monitoramento cuidadoso. A prescrição inadequada de anti-inflamatórios esteroidais para tratar os sinais e sintomas da Covid-19 pode aumentar o risco de infecções fúngicas oportunistas, podendo ser fatais (IQTADAR et al, 2022;GUSMÁN-CASTRO et al, 2021).…”