Case Report
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World J Radiol. Jul 28, 2023; 15(7): 234-240
Published online Jul 28, 2023. doi: 10.4329/wjr.v15.i7.234
Invasive rhinocerebral mucormycosis: Imaging the temporal evolution of disease in post COVID-19 case with diabetes: A case report
Ramakrishna Narra, Shravya Rayapati
Ramakrishna Narra, Shravya Rayapati, Department of Radiodiagnosis, Katuri Medical College, Guntur, Andhra Pradesh 522018, India
Author contributions: Narra R reviewed the manuscript and designed the study; Rayapati S prepared the manuscript, and collected materials for the study.
Informed consent statement: Informed written consent was obtained from the patient and his relatives for the publication of this report and any accompanying images.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016) and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ramakrishna Narra, DNB, MD, MNAMS, Academic Editor, Professor, Department of Radiodiagnosis, Katuri Medical College, Flat No. 30, 1/2 Chandramoulinagar, Guntur, Andhra Pradesh 522018, India. narra.ramki29@gmail.com
Received: April 3, 2023
Peer-review started: April 3, 2023
First decision: May 19, 2023
Revised: June 2, 2023
Accepted: June 26, 2023
Article in press: June 26, 2023
Published online: July 28, 2023
Processing time: 111 Days and 23.3 Hours
Abstract
BACKGROUND

Rhinocerebral mucormycosis (RCM) is a rare, fatal, invasive fungal infection infecting mainly patients with immunocompromised conditions, such as diabetes mellitus, hematologic malignancies, and organ transplantations. Coronavirus disease 2019 (COVID-19) disease in these patients further weakens the immune system due to several factors, including hypoxia, corticosteroid usage (further increasing hyperglycemic status), mechanical ventilation, increased serum ferritin levels, endothelitis due to free radicals, and glucose receptor protein upregulation. Timely diagnosis, judicious treatment decisions, and diabetes control with proper treatment guidelines in patients with coexisting COVID-19 disease can reduce complication rates and improve survival.

CASE SUMMARY

A 75-year-old male patient with diabetes and hypertension diagnosed with COVID-19 presented to the emergency department. Laboratory examinations revealed elevated blood glucose levels, as well as ketone bodies in the urine. He was treated with oxygen and steroids, as well as insulin to correct blood glucose levels. He complained of a headache 10 d later, and imaging demonstrated mucosal thickening in bilateral sphenoidal, ethmoidal, and maxillary sinuses with hyperdense foci in the right maxillary sinus but without central nervous system involvement. Surgical debridement was performed, and a histopathological study revealed fungi hyphae. Systemic antifungals (amphotericin b and posaconazole) were administered. Subsequently, on 15th day he developed right lower limb weakness and left lateral rectus palsy. There was slow but steady progress, and he was discharged. However, he presented to emergency department 1mo later with altered sensorium and poor control of diabetes resulted in an intracranial spread of mucormycosis, which ultimately led to the patient’s poor prognosis and slow recovery.

CONCLUSION

Prompt early diagnosis, judicious treatment decisions, and diabetes control with proper treatment guidelines are necessary in patients with COVID-19 associated invasive RCM to reduce complication rates and improve patient survival.

Keywords: Rhinocerebral mucormycosis; COVID-19 disease; Corticosteroids; Diabetes mellitus; Diabetic ketoacidosis; Case report

Core Tip: Coronavirus disease 2019 associated invasive rhinocerebral mucormycosis is potentially life threatening in patients with uncontrolled diabetes mellitus and diabetic ketoacidosis. Early diagnosis and imaging the disease progression with proper treatment guidelines are essential for reducing the morbidity and mortality in these patients.