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Category: Volume 09 Issue 06 June 2021
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Title: Post Covid-19 Cerebellar Mucormycosis Without Apparent Rhino-Orbital or Ear Involvement – A Case Report

Authors: Dr Poonia Nemi Chand, Mch (Neurosurgery), Director & Senior Consultant, Dr Mangal Akshay, Mch (Neurosurgery), Junior Consultant, Dr Faujdar Mansi, MD (Pathology), Consultant

 DOI: https://dx.doi.org/10.18535/jmscr/v9i6.46

Abstract

Fungal infection of the central nervous system, especially intracranial mucormycosis are very rare. It is not an independent disease, but a secondary opportunistic infectious disease. There is an increase in the incidence of mucormycosis in post Covid-19 infection patients. It can be attributed to impairment of barrier defense, dysfunction of phagocytes and lymphocytes and the use of immunosuppressive medications such as steroids and toclizumab. There is usually some evidence of rhino-orbital or ear involvement in the cases in intracranial mucormycosis. We present a rare case of a 48 year old male patient with a history of Covid-19 infection who presented with apparent isolated cerebellar mucormycosis.

Keywords: Covid-19, Mucormycosis, Intracranial Mucormycosis

Key Message: Cases of invasive mucormycosis have increased in this Covid era. Patients with Covid-19 infection are susceptible to mucormycosis because of impairment of barrier defense, dysfunction of phagocytes and lymphocytes and the use of immunosuppressive medications such as steroids and toclizumab. Treating clinicians need to be aware of the possibility of mucormycosis, in such patients particularly in those with underlying comorbidities. Early diagnosis and treatment of secondary fungal infections can substantially reduce morbidity and mortality.

References

  1. Bouchara JP, Oumeziane NA, Lissitzky JC, Larcher G, Tronchin G, Chabasse D. Attachment of spores of the human pathogenic fungus Rhizopus oryzae to extracellular matrix components. Eur J Cell Biol. 1996; 70(1):76-83.
  2. Wiersinga WJ, Rhodes A, Cheng AC, Peacock SJ, Prescott HC. Pathophysiology, transmission, diagnosis, and treatment of coronavirus disease 2019 (COVID-19): a review. JAMA. 2020; 324(4):782-93.
  3. Waldorf AR. Pulmonary defense mechanisms against opportunistic fungal pathogens. Immunol Ser. 1989; 47:243-71.
  4. Daniela M, Hartmut B, Marc Z, Tobias R, Alexander CK, Urs DA, et al. Mucormycosis of the head and neck. J Craniomaxillofacial Surg. 2012; 40:321-7.
  5. Peter WH, Martin JL. Dexamethasone in hospitalized patients with COVID-19: preliminary report. N Eng J Med. 2020.
  6. Upender W, Abdullah B, Abdullah AM. Cerebro-rhino-orbital mucormycosis: An update. J Infect Public Health. 2012; 5:116-26.
  7. Gollard R, Rabb C, Larsen R, Chandrasoma P. Isolated Cerebral Mucormycosis: Case Report and Therapeutic Considerations. Neurosurgery. 1994; 34:174-7.
  8. Anna S, Fanny L, Andreas HG, Livio P, Stephan Z, Raoul H, et al. Diagnosis and treatment of mucormycosis in patients with hematological malignancies: Guidelines from the 3rd European Conference on Infections in Leukemia (ECIL 3). Haematol. 2013; 98:492-504.
  9. Abu El-Naaz I, Leiser Y, Wolff A, Peled M. The surgical management of rhinocerebral mucormycosis. J Craniomaxillofac Surg. 2013; 41:291-5.
  10. Munir N, Jones NS. Rhinocerebral mucormycosis with orbital and intracranial extension: A case report and review of optimum management. Laryngol Otol. 2007; 121:192-5.

Corresponding Author

Dr Akshay Mangal