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Brain & Heart Surviving rhino-orbital-cerebral mucormycosis

A

B C

Figure 3. Status of patient post-reconstruction surgery. (A) Raw area
of thigh (split skin graft site) covered by occlusive dressing. (B) Flap
(anterolateral thigh) filling the large tissue defect with a split skin graft
cover. (C) Split skin graft necrosis with only partial uptake of the graft.
forms of treatment, as our patient did (amphotericin B +
posaconazole + FESS + exenteration) . The main inferences
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of this study were that corticosteroids and diabetes mellitus
are the most important predisposing factors for COVID-19-
associated ROCM, and it emphasized the necessity of post-
recovery follow-up for COVID-19 patients . In our case, the
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patient developed symptoms approximately 2 months after
recovering from COVID-19. At the time of writing, he had
been under observation for the past 2 years and remained
in our follow-up. His case signifies that COVID-19 can act
as an independent risk factor for ROCM.
To date, only a literature review summarizing 11 cases
of ROCM in immunocompetent individuals has been
published (Table 1).
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Out of eleven cases reviewed, eight patients survived
only after undergoing extensive radical debridement and Figure 4. A timeline chart detailing the patient’s journey through multiple
surgeries across various specialties, highlighting the invasive course of the
orbital exenteration, a similar scenario to our patient disease and the requirement of a multidisciplinary approach with a long
(Figure 4). This indicates that even if the disease is follow-up.
localized, surgeons should not try to preserve vision first Abbreviations: ENT: Ear nose throat; FESS: Functional endoscopic sinus
but should aim to preserve life, keeping the invasive and surgery; SSG: Split skin graft.
arduous nature of the disease course in mind. Our report is
noteworthy for highlighting the challenge of determining loss of facial cosmesis, and long hospital stays. The invasive
the appropriate extent of surgical intervention. This nature of ROCM is evident in the patient’s journey through
case raises questions about considering the disease multiple surgeries.
trajectory when planning surgical interventions. Surgeons Before the COVID-19 pandemic, Mucor was a rare
must consider the course of the disease and potential entity in India, with only two large retrospective series
complications arising from residual infected tissue before reported from PGIMER Chandigarh. These studies,
deciding on surgical debridement margins. Increasing the covering 129 cases over 10 years (1990 – 1999) and
4
radicality of debridement and decreasing the time between 178 cases over the subsequent 5 years (2000 – 2004) , raised
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clinical presentation and surgery can help prevent further awareness about the threat of invasive zygomycosis. They
invasion of adjacent organs, serial debridement surgeries, prompted the development of an institutional zygomycosis

Volume 2 Issue 2 (2024) 5 doi: 10.36922/bh.2083