Rhino-orbital mucormycosis in a COVID-19 patient.
Rhino-orbital mucormycosis in a COVID-19 patient.
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DOI：
10.1136/bcr-2021-244232
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发表时间：
2021-06-24
期刊：
影响因子：
0.9
通讯作者：
Singh S
中科院分区：
文献类型：
--
作者：
Baskar HC;Chandran A;Reddy CS;Singh S
一名 28 岁男性患者有 5 天突然视力丧失和右眼肿胀病史，并有咳嗽和发烧病史。他否认之前有任何眼外伤或鼻部症状。除了 5 年前的急性甲型病毒性肝炎病史之外，他之前的病历排除了任何免疫抑制的原因。一般检查无异常。眼部检查发现右眼突出，结膜充血、水肿、上下眼睑红斑肿胀（图 1A）。他否认右眼有光知觉，瞳孔固定散大，眼肌完全麻痹。其他眼睛和鼻子的检查没有发现异常。口咽拭子逆转录酶 PCR (RT-PCR) 结果显示 SARS-CoV-2 病毒呈阳性，循环阈值为 30。血常规检查未见异常。空腹和餐后2小时血糖值均在正常范围内，糖化血红蛋白值为5.5%。鼻子和鼻旁窦及眼眶的增强 CT 扫描显示右侧锥内和球后软组织密度以及右侧筛窦粘膜增厚（图 1B）。他的胸部 X 光片显示双侧弥漫性毛玻璃样混浊，与 COVID-19 肺炎一致（图 1C）。眼眶活检显示广泛的无隔膜真菌菌丝，提示毛霉菌病。由于健康成人存在机会性真菌感染，因此排除了包括 HIV（ELISA 检测）和低补体血症在内的免疫缺陷综合征。静脉注射广谱抗生素（美罗培南 500 毫克，每天三次，替考拉宁 200 毫克，每天两次）用于治疗可能发生的 COVID-19 肺炎细菌重复感染，以及脂质体两性霉素 B 治疗鼻眼眶毛霉菌病。活动性暴发性毛霉菌病的存在排除了皮质类固醇治疗的使用。患者在全身麻醉下接受了右侧眼眶切除术和筛窦清创术，并使用最佳的个人防护设备采取了普遍的预防措施。他已完成肠外抗真菌治疗过程，在 COVID-19 恢复后 2 个月的随访期内，临床上已无疾病。 犀眼眶毛霉菌病是一种由毛霉科血管侵袭性真菌引起的急性暴发性真菌感染，通常见于免疫功能低下受试者和失代偿性糖尿病患者。 1 虽然真菌接种的主要部位是鼻子和鼻旁窦，但这些侵袭性真菌
A 28-year-old male patient presented with a 5-day history of sudden vision loss and swelling of the right eye along with a history of cough and fever. He denied any previous ocular trauma or nasal symptoms. His previous medical charts ruled out any cause for immunosuppression except a history of acute viral hepatitis-A 5 years back. General examination was unremarkable. Ocular examination revealed proptosis of the right eye with conjunctival congestion, chemosis, erythematous and swollen upper and lower eyelids (figure 1A). He denied perception of light on the right eye with a fixed dilated pupil and complete ophthalmoplegia. Examination of other eye and nose was unremarkable. An oropharyngeal swab for reverse-transcriptase PCR (RT-PCR) was positive for SARS-CoV-2 virus with a cycle threshold value of 30. The routine blood investigations were unremarkable. The fasting and 2-hour postprandial blood sugar values were within normal limits with a haemoglobin A1c value of 5.5%. A contrastenhanced CT scan of nose and paranasal sinus with orbit showed right intraconal and retrobulbar soft tissue density along with mucosal thickening in the right ethmoid sinus (figure 1B). His chest radiograph showed diffuse bilateral ground-glass opacities consistent with COVID-19 pneumonia (figure 1C). An orbital biopsy revealed broad aseptate fungal hyphae suggestive of mucormycosis. Immune deficiency syndromes including HIV (ELISA test) and hypocomplementemia were ruled out owing to the presence of an opportunistic fungal infection in a healthy adult. Intravenous broad-spectrum antibiotics (meropenem 500 mg thrice a day and teicoplanin 200 mg twice a day) were administered for probable bacterial superinfection of COVID-19 pneumonia along with liposomal amphotericin-B for rhino-orbital mucormycosis. The presence of active fulminant mucormycosis precluded the use of corticosteroid therapy. The patient underwent right-side orbital exenteration and ethmoid sinus debridement under general anaesthesia with universal precautions using optimum personal protective equipment. He had completed the course of parenteral antifungal therapy and clinically disease free at 2-month follow-up period post COVID-19 recovery.Rhino-orbital mucormycosis is an acute and fulminant fungal infection caused by the angioinvasive fungi of the family Mucoraceae and seen usually among immunocompromised subjects and patients with decompensated diabetes. 1 Though the primary site of fungal inoculation is the nose and paranasal sinuses, these aggressive fungi
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影响因子：
3.6
作者：
Werthman-Ehrenreich, Amanda
通讯作者：
Werthman-Ehrenreich, Amanda
影响因子：
3.1
作者：
Sen M;Lahane S;Lahane TP;Parekh R;Honavar SG
通讯作者：
Honavar SG
DOI：
10.7759/cureus.10726
发表时间：
2020-09-30
期刊：
Cureus
影响因子：
--
作者：
Mehta S;Pandey A
通讯作者：
Pandey A
冠状病毒疾病（COVID-19）相关的粘膜细胞增多症（CAM）：病例报告和文献综述。
影响因子：
5.5
作者：
Garg D;Muthu V;Sehgal IS;Ramachandran R;Kaur H;Bhalla A;Puri GD;Chakrabarti A;Agarwal R
通讯作者：
Agarwal R
影响因子：
11.8
作者：
Petrikkos, George;Skiada, Anna;Kontoyiannis, Dimitrios P.
通讯作者：
Kontoyiannis, Dimitrios P.