International Medical Case Reports Journal (May 2022)

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

  • Alemayehu FM,
  • Abate HK,
  • Soboka TA,
  • Huluka DK,
  • Worke AB,
  • Abrie MT,
  • Dibaba DK,
  • Asnake YB

Journal volume & issue
Vol. Volume 15
pp. 251 – 257

Abstract

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Fikremariam Melkeneh Alemayehu,1 Hannibal Kassahun Abate,2 Tariku Assefa Soboka,3 Dawit Kebede Huluka,4 Alemayehu Bedane Worke,5 Mahlet Tsegaye Abrie,6 Dawit Kebebaw Dibaba,7 Yilkal Birhanu Asnake8 1General Practitioner, Intensive Care Unit Trained, Department of Intensive Care Unit, Ministry of Health (MOH) Eka Kotebe General Hospital, Addis Ababa, Ethiopia; 2Internal Medicine Chief Resident (PGY-3), Department of Internal Medicine, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia; 3Anesthesiologist and Intensivist, Department of Intensive Care Unit, MOH Eka Kotebe General Hospital, Addis Ababa, Ethiopia; 4Internist, Pulmonologist and Critical Care Subspecialist, Department of Internal Medicine, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia; 5Radiologist, Subspecialist in Body Imaging and Neuroradiology, Department of Radiology, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia; 6Head and Chief General Ophthalmologist, Department of Ophthalmology, MOH Eka Kotebe General Hospital, Addis Ababa, Ethiopia; 7Otorhinolaryngologist, Department Head of Otorhinolaryngology, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia; 8Ophthalmologist, Department of Ophthalmology, MOH Eka Kotebe General Hospital, Addis Ababa, EthiopiaCorrespondence: Fikremariam Melkeneh Alemayehu, PO Box 100571, Kirkos Sub City, Addis Ababa, Ethiopia, Tel +251921467414, Email [email protected]: 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.Keywords: COVID-19, mucormycosis, zygomycotic, fungal infection, anti-fungal

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