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Rhino-Orbital-Cerebral Mucormycosis in a Young Diabetic Patient with COVID-19 in Ethiopia: A Case Report.

Authors:
Fikremariam Melkeneh Alemayehu Hannibal Kassahun Abate Tariku Assefa Soboka Dawit Kebede Huluka Alemayehu Bedane Worke Mahlet Tsegaye Abrie Dawit Kebebaw Dibaba Yilkal Birhanu Asnake

Int Med Case Rep J 2022 19;15:251-257. Epub 2022 May 19.

Ophthalmologist, Department of Ophthalmology, MOH Eka Kotebe General Hospital, Addis Ababa, Ethiopia.

Background: There has been a rise in secondary invasive fungal infections reported in COVID-19 patients globally. We report the first published case of COVID-19 associated rhino-orbital-cerebral mucormycosis in Africa in a newly diagnosed diabetic female who presented with diabetic ketoacidosis (DKA) and discuss the prevalence and risk factors of fungal co-infection with the clinical presentation, diagnosis, and management of mucormycosis in COVID-19.

Case Presentation: A 39 years old female patient was admitted to ICU with a diagnosis of severe COVID-19 and newly diagnosed diabetes mellitus (DM) with DKA based on HgbA1c of 13.8% and positive RT-PCR. The patient was treated with dexamethasone in line with evidence in the RECOVERY trial and developed right facial and orbital swelling on her second hospital day. Brain MRI showed characteristic peri-sinonasal invasion with central nervous system (CNS) involvement, features suggestive of invasive fungal infection. Despite all medical and surgical treatments including liposomal amphotericin B and debridement, the patient died within 7 days of symptom onset.

Conclusion: Clinicians should be aware of the potential for Rhino-Orbital-Cerebral Mucormycosis (ROCM) as a complication of COVID-19, especially in steroid taking diabetics who develop periorbital swelling and sinusitis. Timely diagnosis and multidisciplinary treatment are very critical.

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http://dx.doi.org/10.2147/IMCRJ.S364591DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9126225PMC
May 2022

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