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VOLUME 13 , ISSUE 4 ( October-December, 2022 ) > List of Articles
Uma Nataraj, Merlin Babu, Frenali Godhani
Keywords : Coronavirus disease 2019, Diabetes, Fungal infection, Mucormycosis, Rhino-orbital, Tuberculosis
Citation Information : Nataraj U, Babu M, Godhani F. A Rare Case of Rhino-orbital Mucormycosis with Intracranial Tuberculosis in Latent Post Coronavirus Disease 2019 Diabetic Patient. Int J Head Neck Surg 2022; 13 (4):104-108.
License: CC BY-NC 4.0
Published Online: 21-01-2023
Copyright Statement: Copyright © 2022; The Author(s).
Aim: To report a rare case of rhino-orbital mucormycosis with intracranial tuberculosis in a latent post-coronavirus disease 2019 (COVID-19) diabetic patient. Background: Mucormycosis has been found to have a predilection for COVID-19 patients, while diabetes mellitus and other immunocompromised conditions act as independent risk factors for both. In this case, there is an additional immunocompromised risk factor of tuberculosis. Case description: We report the case of a 61-year-old male patient, a long-standing diabetic with positive COVID antibodies, in an unvaccinated patient diagnosed with rhino-orbital mucormycosis with suspected intracranial extension. Magnetic resonance imaging (MRI) of the brain, paranasal sinuses (PNS), and orbit revealed sinusitis, predominantly involving both maxillary, ethmoid, and right medial frontal sinuses, with intracranial extension in the right basifrontal brain parenchyma, and involvement of right medial extraconal orbit abutting muscles. Potassium hydroxide (KOH) mount of nasal swab and nasal biopsy showed broad branching aseptate hyphae consistent with mucormycosis. Functional endoscopic sinus surgery (FESS) and neurosurgical intervention, together with microbiological evidence, supported the diagnosis of rhino-orbital mucormycosis with intracranial tuberculosis. Due to underlying uncontrolled diabetes and tuberculosis, it was difficult to manage medically. Amphotericin, the mainstay of treatment for mucormycosis being nephrotoxic, and as the patient has diabetic nephropathy, was an additional challenge to manage as he developed severe renal dysfunction. He was successfully managed with surgical intervention involving FESS, medial wall orbitotomy, frontal craniotomy with debridement, and antituberculosis treatment. Conclusion: Diagnosis, reversal of risk factors, surgical debridement of infected tissue, and appropriate therapy forms the mainstay of the management of mucormycosis. The contributory risk factors should be managed adequately to decrease and control morbidity. Clinical significance: Early and proper diagnosis of mucormycosis in an unvaccinated patient with positive covid antibodies, diabetes mellitus, and intracranial tuberculosis is essential and will further require aggressive management and surgical intervention at the earliest stage possible so as to prevent mortality.