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Yang X, Ding Y, Liu Y, Shi Y, Sun X. A 17-year-old student with ankle sprain to leg amputation. J Surg Case Rep 2024; 2024:rjae003. [PMID: 38333560 PMCID: PMC10850049 DOI: 10.1093/jscr/rjae003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 01/05/2023] [Indexed: 02/10/2024] Open
Abstract
Cutaneous mucormycosis with ischemic complications is a life-threatening condition with high mortality rates, particularly in immunocompromised individuals. The incidence of mucormycosis has increased during the COVID-19 pandemic due to reduced immunity. We present the case of a 17-year-old high school student who experienced a sprained left lower extremity, followed by worsening pain and swelling due to the topical application of unknown local herbs. Eighteen days after the injury, she was admitted to our department in a comatose state with left lower limb ischemia. The patient had a history of uncontrolled diabetes mellitus and displayed a necrotic lesion on her left ankle, suggestive of invasive infectious fungi disease. Diagnostic procedures, including tissue staining and molecular analysis, identified Rhizopus oryzae as the causative organism. Administering amphotericin B yielded marked improvement, but the patient necessitated a mid-thigh amputation to curtail the infection's advance, culminating in her successful discharge post-treatment.
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Affiliation(s)
- Xi Yang
- Department of General Surgery (Vascular Surgery), The Affiliated Hospital of Southwest Medical University, Luzhou 646000, China
- Cardiovascular and Metabolic Diseases Key Laboratory of Luzhou, Luzhou 646000, Sichuan, China
- Key Laboratory of Medical Electrophysiology, Ministry of Education & Medical Electrophysiological Key Laboratory of Sichuan Province, Collaborative Innovation Center for Prevention and Treatment of Cardiovascular Disease of Sichuan Province, Institute of Cardiovascular Research, Southwest Medical University, Luzhou 646000, Sichuan, China
| | - Yinhuan Ding
- Department of Laboratory Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, China
| | - Yong Liu
- Department of General Surgery (Vascular Surgery), The Affiliated Hospital of Southwest Medical University, Luzhou 646000, China
- Cardiovascular and Metabolic Diseases Key Laboratory of Luzhou, Luzhou 646000, Sichuan, China
- Key Laboratory of Medical Electrophysiology, Ministry of Education & Medical Electrophysiological Key Laboratory of Sichuan Province, Collaborative Innovation Center for Prevention and Treatment of Cardiovascular Disease of Sichuan Province, Institute of Cardiovascular Research, Southwest Medical University, Luzhou 646000, Sichuan, China
| | - Yixue Shi
- Department of General Surgery (Vascular Surgery), The Affiliated Hospital of Southwest Medical University, Luzhou 646000, China
- Cardiovascular and Metabolic Diseases Key Laboratory of Luzhou, Luzhou 646000, Sichuan, China
- Key Laboratory of Medical Electrophysiology, Ministry of Education & Medical Electrophysiological Key Laboratory of Sichuan Province, Collaborative Innovation Center for Prevention and Treatment of Cardiovascular Disease of Sichuan Province, Institute of Cardiovascular Research, Southwest Medical University, Luzhou 646000, Sichuan, China
| | - Xiaolei Sun
- Department of General Surgery (Vascular Surgery), The Affiliated Hospital of Southwest Medical University, Luzhou 646000, China
- Cardiovascular and Metabolic Diseases Key Laboratory of Luzhou, Luzhou 646000, Sichuan, China
- Key Laboratory of Medical Electrophysiology, Ministry of Education & Medical Electrophysiological Key Laboratory of Sichuan Province, Collaborative Innovation Center for Prevention and Treatment of Cardiovascular Disease of Sichuan Province, Institute of Cardiovascular Research, Southwest Medical University, Luzhou 646000, Sichuan, China
- Department of Interventional Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, China
- Nucleic Acid Medicine of Luzhou Key Laboratory, Southwest Medical University, Luzhou 646000, China
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Kurup LR, Singh H, Sharma SB, Janakiram TN. Outcome of Total Surgical Debridement of Covid Associated Rhino-Orbito-Cerebral Mucormycosis Based on a New Surgical Staging System: A Cohort Study. Indian J Otolaryngol Head Neck Surg 2024; 76:298-308. [PMID: 38440527 PMCID: PMC10908694 DOI: 10.1007/s12070-023-04151-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 08/18/2023] [Indexed: 03/06/2024] Open
Abstract
To propose a surgical staging system with management protocol for post-covid Rhino-orbito-cerebral mucormycosis (ROCM) with central skull base osteomyelitis. A prospective cohort study of a total of 193 post-covid ROCM patients was conducted between May 2021 and January 2022 at a tertiary care centre. Patients were assessed radiologically and staged from I to V. Follow up period was 16 months and the surgical outcome in terms of recurrent disease was assessed. A total of 193 patients (129 primary and 64 revision) were studied. Maxilla was found to be the epicenter of anterior disease (69.3%) and pterygoid wedge was noted to be the epicenter of posterior disease (85.6%). More than 65% of our patients, at the time of presentation, presented with involvement of the central skull base. Intracranial disease was noted in 13.9% of patients and the mortality rate was 6.2%. This staging system provides a systematic step-by-step protocol for the management of ROCM, with emphasis on meticulous disease clearance at the central skull base.
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Brent AA, Chen O, Eshaq M, Lowe L, Chan MP. Detection of antibody-coated Mucor in skin biopsy by direct immunofluorescence. J Cutan Pathol 2023. [PMID: 37062590 DOI: 10.1111/cup.14435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 03/03/2023] [Accepted: 03/27/2023] [Indexed: 04/18/2023]
Abstract
Cutaneous mucormycosis may be caused by direct inoculation or hematogenous spread of mucormycetes in immunocompromised patients. Skin biopsy is characterized by a deep fungal infection with frequent angioinvasion. The fungal hyphae can usually be identified on H&E stain. We report a case of cutaneous angioinvasive mucormycosis in which the fungi were also visualized on direct immunofluorescence. A 57-year-old patient with relapsed myelodysplastic syndrome status-post allogeneic hematopoietic cell transplant, diabetes mellitus, and graft-versus-host disease presented with painful, palpable, dark-red to violaceous retiform purpuric plaques. Light microscopy of punch biopsy revealed numerous broad, ribbon-like, pauci-septate hyphae in the dermis with angioinvasion, consistent with mucormycosis. Direct immunofluorescence performed on a concurrent biopsy to exclude immune complex vasculitis showed smooth IgG, IgA (weak), IgM (faint), and C3 deposition on the hyphal structures, compatible with antibody-coated fungi. Tissue culture subsequently confirmed Mucor species. Although mucormycosis was readily diagnosable on routine light microscopy in this case, recognition of the unique phenomenon of antibody-coated fungi can be crucial when the invasive fungi are sparse or only present in the direct immunofluorescence specimen.
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Affiliation(s)
- Ashley A Brent
- Department of Pathology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Olivia Chen
- Department of Dermatology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Milad Eshaq
- Department of Dermatology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Lori Lowe
- Department of Pathology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Department of Dermatology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - May P Chan
- Department of Pathology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Department of Dermatology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
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Cappell MS, Tobi M, Friedel DM. The Impact of COVID-19 Infection on Miscellaneous Inflammatory Disorders of the Gastrointestinal Tract. Gastroenterol Clin North Am 2023; 52:115-138. [PMID: 36813420 PMCID: PMC9537253 DOI: 10.1016/j.gtc.2022.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
The novel coronavirus pandemic of COVID-19 has emerged as a highly significant recent threat to global health with about 600,000,000 known infections and more than 6,450,000 deaths worldwide since its emergence in late 2019. COVID-19 symptoms are predominantly respiratory, with mortality largely related to pulmonary manifestations, but the virus also potentially infects all parts of the gastrointestinal tract with related symptoms and manifestations that affect patient treatment and outcome. COVID-19 can directly infect the gastrointestinal tract because of the presence of widespread angiotensin-converting enzyme 2 receptors in the stomach and small intestine that can cause local COVID-19 infection and associated inflammation. This work reviews the pathopysiology, clinical manifestations, workup, and treatment of miscellaneous inflammatory disorders of the gastrointestinal tract other than inflammatory bowel disease.
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Affiliation(s)
- Mitchell S Cappell
- Division of Gastroenterology, Department of Medicine, Aleda E. Lutz Veterans Hospital, Gastroenterology Service, Main Building, Room 3212, 1500 Weiss Street, Saginaw, MI 48602, USA.
| | - Martin Tobi
- Department of Research and Development, John D. Dingell Veterans Affairs Medical Center, 4747 John R. Street, Detroit, MI 48201, USA
| | - David M Friedel
- Division of Therapeutic Endoscopy, Division of Gastroenterology, Department of Medicine, NY of New York University Langone Hospital, 259 1st Street, Mineola, NY 11501, USA
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Wankhade BS, Abdel Hadi AM, Alrais GZ, Alrais ZF, Elzayyat A. Post-COVID-19 Cerebral Pheohyphomycosis due to Rhinocladiella mackenziei: A Middle Eastern Replica of Post-COVID-19 Mucormycosis? J Glob Infect Dis 2022; 14:173-174. [PMID: 36636300 PMCID: PMC9831205 DOI: 10.4103/jgid.jgid_105_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 06/13/2022] [Accepted: 06/21/2022] [Indexed: 11/05/2022] Open
Affiliation(s)
- Bhushan Sudhakar Wankhade
- Department of Surgical Intensive Care, Rashid Hospital, Oud Metha, Dubai, UAE,Address for correspondence: Dr. Bhushan Sudhakar Wankhade, Department of Surgical Intensive Care Unit, Rashid Hospital, PO Box 4545, Oud Metha, Dubai, UAE. E-mail:
| | | | | | - Zeyad Faoor Alrais
- Department of Surgical Intensive Care, Rashid Hospital, Oud Metha, Dubai, UAE
| | - Ahmad Elzayyat
- Department of Surgical Intensive Care, Rashid Hospital, Oud Metha, Dubai, UAE
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