Rhino-Orbital-Cerebral Mucormycosis in a Post-COVID-19 Patient from Peru

Abstract

Mucormycosis has been reported increasingly in patients affected by COVID-19, especially in India where the first cases were described. In Latin America, there is limited information about this association, mainly coming from Brazil, Mexico, and Peru. Herein, we report the case of a 66-year-old female that presented with rhino-orbital-cerebral mucormycosis, diabetic ketoacidosis, and COVID-19. The patient had the compromise of all the sinuses, orbital invasion, and intracranial extension. Isavuconazole was promptly initiated because amphotericin B was not available. She had a single open surgical debridement of necrotic tissues at the beginning of the diagnosis then multiple manual sessions to clear the residual or recurrent disease during approximately 5 months. Isavuconazole was effective and well-tolerated for 10 months without side effects. We highlight the importance of considering mucormycosis in post-COVID-19 patients with uncontrolled diabetes. The report emphasizes the favorable outcome of isavuconazole as an alternative therapy.

Amphotericin B, itraconazole, posaconazole and isavuconazole minimum inhibitory concentration against 85 strains of Rhizopus spp, isolated from the patients having COVID-19 associated mucormycosis in North India

“…R. arrhizus has been reported as a most common cause of mucormycosis in the literature. [14][15][16] However, during COVID-19 pandemic, rare Mucorales such as Rhizopus microsporus and R. homothallicus were also isolated from patients having CAM. 17 Thus, identification of the causative Mucorales helps in selecting the appropriate antifungal agents as varied MIC of tested antifungals were noted against the isolated Mucorales.…”

From Bilateral Periorbital Necrotic Wound to Fungal Brain Abscess: A Complicated Case of COVID-19-Associated Mucormycosis

“…Debridement is often disfiguring in instances of rhinocerebral infection, requiring the removal of the palate, nasal cartilage, and orbit. Recent evidence suggests that endoscopic debridement can be accomplished with minimal tissue loss [ 19 , 20 ]. The treatment of choice for initial antifungal therapy in CAM is intravenous amphotericin B.…”

Mucormicosis oral asociada a COVID-19 y diabetes mellitus: descripción de un caso

“…La enfermedad por coronavirus (COVID-19) es causada por SARS- CoV2. La infección por COVID-19 en presencia de factores de riesgo como la diabetes mellitus, el uso de corticoides, la sinusitis no bacteriana, la infección por el virus de la inmunodeficiencia humana y los antecedentes de trasplantes favorecen la proliferación de infecciones fúngicas oportunistas como la mucormicosis 4 .…”