Rhino-Orbital Cerebral Mucormycosis in a Patient With Diabetic Ketoacidosis: A Case Report and Literature Review

Dong, Nan; Jordan, Ashly E.; Shen, Xiaozhu; Wu, Xuan; Guo, Xianghong; Zhao, Hongru; Wang, Yajuan; Wang, Dapeng; Fang, Qi

doi:10.3389/fneur.2022.815902

Cited by 9 publications

(5 citation statements)

References 46 publications

(52 reference statements)

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“…ROCM is a rare but fatal fungal infection involving the cerebellar and orbital sinuses as proposed by Champion early in 1969. [ 3 ] A sudden and rapid rise in mucormycosis incidence was observed during the second wave of the COVID-19 pandemic. The global prevalence of mucormycosis before the COVID-19 pandemic ranges from 0.005 to 1.7 per million population and it is almost 80 times higher in India (0.14/1000) compared to other world regions.…”

Section: Discussionmentioning

confidence: 99%

“…[ 2 ] Rhino-orbital-cerebral mucormycosis (ROCM) is the most common clinical presentation of mucormycosis. [ 3 ] Symptoms of ROCM include headache, facial pain, facial/orbital swelling, and/or nasal eschar. Progressive ROCM infection results in necrosis of the head and neck, paranasal sinuses, proptosis of the eyeball, and/or ptosis of the eyelid with possible central nervous system (CNS) involvement.…”

Section: Introductionmentioning

confidence: 99%

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Rhino orbital cerebral mucormycosis: A life-threatening complication of coronavirus diseases 2019 in an uncontrolled diabetic patient

Alsayed¹,

Al-Qurain²,

Alrais³

2024

Turk J Emerg Med

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Mucormycosis is a progressive and life-threatening disease that has been increasingly reported in patients infected by coronavirus diseases 2019 (COVID-19). We describe a case of rhino-orbital mucormycosis with central nervous system involvement resulting in bilateral blindness and intracranial extension in a patient with uncontrolled diabetes mellitus (DM) and mild COVID-19 infection. A 35-year-old obese male, recently diagnosed with DM, presented to the emergency department suffering from dizziness, headache, speech difficulty, and facial weakness. His glycosylated hemoglobin was 10.4% and his reverse transcriptase–polymerase chain reaction (PCR) test came positive for COVID-19. Ocular examination revealed left eye proptosis, ophthalmoplegia, and lid edema with no ocular movement. Imaging studies showed pansinusitis and periorbital and orbital cellulitis with intracranial involvement. Histopathology and biopsy examination confirmed mucormycosis. Medical management included glucose control and liposomal amphotericin B therapy. Septoplasty and functional endoscopic sinus surgery was performed as emergency procedures. The patient survived with bilateral blindness. In this case, we described the importance of considering mucormycosis in COVID-19 patients with uncontrolled diabetes, particularly those presenting with sinusitis, headache, and orbital edema symptoms. Despite intensive antifungal therapy and surgical intervention, it is a serious opportunistic fungal infection associated with long-term complications.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Rhino orbital cerebral mucormycosis: A life-threatening complication of coronavirus diseases 2019 in an uncontrolled diabetic patient

Alsayed¹,

Al-Qurain²,

Alrais³

2024

Turk J Emerg Med

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“…At present, there are no effective clinical biomarkers for ROCM diagnosis ( Walsh et al., 2012 ; Lass-Florl, 2017 ). Previous studies have revealed that up to 90% of ROCM cases are undiagnosed and untreated ( Walsh et al., 2012 ; Dong et al., 2022 ). In our present case, we obtained a rapid and accurate etiological result within 24 h with the help of a novel technology called mNGS, which has emerged as a fast, precise, and effective laboratory technology.…”

Section: Discussionmentioning

confidence: 99%

Rhino-orbital-cerebral mucormycosis caused by Rhizopus arrhizus diagnosis via metagenomics next-generation sequencing: a case report

Li,

Ge,

Xin

et al. 2024

Front. Cell. Infect. Microbiol.

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Rhino-orbital-cerebral mucormycosis (ROCM) is a rare, invasive, and fatal fungal disease that is often easily misdiagnosed in the early stages due to the lack of specific clinical manifestations and adequate auxiliary examinations. Early diagnosis and timely therapy are essential for successful treatment. In this report, we presented a 46-year-old man with diabetes who experienced gradual vision loss, right ptosis, swelling, and headaches that progressively worsened to death within 4 days after admission. It was finally confirmed as a fungal Rhizopus arrhizus infection by metagenomics next-generation sequencing (mNGS). Our report has proved that mNGS testing should be strongly recommended in highly suspected patients.

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“…Mucormycosis, caused by opportunistic pathogenic fungi that belong to the order Mucorales, is a difficult-to-diagnose rare disease with high mortality that commonly occurs in patients with impaired immune status, particularly those with diabetes mellitus, hematological malignancy, and neutropenia ( Dong et al., 2022 ). According to literature review, this is the first reported patient with AML who developed disseminated infection caused by M. indicus ( Supplementary Table S1 ).…”

Section: Discussionmentioning

confidence: 99%

Mucor indicus caused disseminated infection diagnosed by metagenomic next-generation sequencing in an acute myeloid leukemia patient: A case report

Shen

Li²,

Baker³

et al. 2023

Front. Cell. Infect. Microbiol.

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BackgroundMucormycosis commonly occurs in immunosuppressed patients with hematological diseases, which can be life-threatening. However, many cases are often misdiagnosed due to lack of specific clinical manifestations. Additionally, the traditional blood culture or serological testing, with a high false-negative rate, is time-consuming. Thus, precise and timely diagnosis of infections is essential for the clinical care of infected patients.Case presentationWe report a 29-year-old Chinese man with acute myeloid leukemia (AML) who developed febrile neutropenia after the first course of induction chemotherapy. He received empirical antibiotics, which did not relieve his symptoms. No pathogen was detected by traditional microbiologic assays, while Mucor indicus was identified by metagenomic next-generation sequencing (mNGS) in the blood specimen. Liposomal amphotericin B (LAmB) was used, resulting in the patient’s temperature returning to normal. A few days later, abdominal computed tomography (CT) scan showed multiple liver abscesses; fluorescence staining, histopathology, and mNGS identified the causative agent—M. indicus. Posaconazole was combined with LAmB as long-term antifungal treatment. Finally, the patient received allogeneic hematopoietic stem cell transplantation successfully after controlled infection. During follow-up 1 year after transplantation, the number of liver abscesses was reduced to one and remained stable.ConclusionThis report described the first case of an AML patient diagnosed with culture-negative disseminated infections caused by M. indicus leading to rare hepatic manifestations using mNGS of peripheral blood and liver biopsy. LAmB combined with posaconazole was given in time, resulting in a favorable outcome. mNGS is a new method that assists in detecting the probable pathogen and increases the accuracy of identifying an etiology.

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Rhino-Orbital Cerebral Mucormycosis in a Patient With Diabetic Ketoacidosis: A Case Report and Literature Review

Cited by 9 publications

References 46 publications

Rhino orbital cerebral mucormycosis: A life-threatening complication of coronavirus diseases 2019 in an uncontrolled diabetic patient

Rhino orbital cerebral mucormycosis: A life-threatening complication of coronavirus diseases 2019 in an uncontrolled diabetic patient

Rhino-orbital-cerebral mucormycosis caused by Rhizopus arrhizus diagnosis via metagenomics next-generation sequencing: a case report

Mucor indicus caused disseminated infection diagnosed by metagenomic next-generation sequencing in an acute myeloid leukemia patient: A case report

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