AN INDIRECT BUT UNFORTUNATE COMPLICATION OF COVID 19

48yrs/M Hospitlised for DKA with H/o Covid 19 Pneumonia 2mnths back. He received antiviral Remdesivir, Methyl prednisolone 40mg thrice daily for 5 days, 40mg twice daily for 5 days, 20 mg twice daily for 7 days was given rehabilitation care and discharged with a tapering dose of methyl prednisolone from 16mg.After that,the Patient presented with presented with left eye complete ptosis, facial pain for 5 days with left sided headache with no symptoms of rhinitis or sinusitis. Nasal swab for Covid 19 was sent found to be negative.HRCT chest done,Which shows 10/25 score.CEMRI Brain with PNS shows Cavernous sinus thrombosis with pansinusitis?Fungal. Admission Glucose was 450mg/dl with ketosis managed with Insulin infusion and Human Mixtard 30:70. Chief Complaints Headache,Left eye dropping,Facial pain History Covid 19 Pneumonia,Diabetes mellitus Vitals Spo2 -94 on RA Physical Examination Proptosis of left eye with chemosis and opthalomoplegia present,fixed pupil, GCS - 15/15 Investigations COVID 19 RT PCR NEGATIVE,CRP -40,D dimer -550,TLC - 22000. Diagnosis Mucormycosis Management Biopsy of nasal turbinate done report enclosed, Aggressive debridement were done. He was initiated on conventional amphotericin B (given for 11 days) with Broad spectrum Antibiotics and Ecosprin for Cavernous sinus thrombosis.

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Sir - a very interesting case,of biopsy proved MUCORMYCOSIS with secondary cavernous sinus thrombosis - ipsilateral internal carotid artery occlusion , multiple cerebral infarcts and cranial nerve palsy ( secondary ) Antifungal therapy with Amphotericin - B and posaconazole needs to started with

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Very useful demonstrative case. We recently saw an exactly similar case in an obese female of 45 yr with uncontrolled diabetes with palatal ulcers which on tissue biopsy confirmed Mucormycosis. Surprisingly, our pt was admitted with multiple cranial nerve palsy as well as multiple embolic infarcts with ipsilateral ICA occlusion. I shall try to present it later, now I'm preparing the case report.

Thank you doctor
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Very hot topic of Black fungus (Mucormycosis) nicely depicted ... Would like to share a valuable information here... Most guidelines including AIIMS have advised to give short course of Steroids for 5-7 days without tapering...but most physicians are still practising the same tapering regime... You all are requested not to prolong steroid course in Covid patients as we are witnessing increasing number of black fungus everyday....

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Known as MUCORMYCOSIS zNLCKNFUNGUS APPERARS AS CRSTED KEDION ON FACE INVOLVES 1 SINDUSES TO CAUSE FRONTAL MAXILLARY OR ETHEMIIDAL SINUSITIS ORBIT AND EYE PROOTOSIS BLINDNESS BRAIN INVOKVEMENT LUNGS PNUEMONIA

I want to talk to someone as mucormycosis as medical officer. Thank you.
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Congratulations! Your case has been selected as Case of the day and you have been awarded 5 points for sharing the case. Keep posting your interesting cases, Happy Curofying!

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Good case.Thanks for sharing Dr Prashant ,Steroid use and Dm - are risk factors for Mucormycosis .

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NICE ILLUSTRATION LEFT EYE PTOSIS AND RACIAL PAIN ARE ATYPICAL OCCULAR COMPLECATATIOBS OF VOVID KIND OF MEUROPHTHALMIC COMPLECATIONS

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Left eye ptosis covid 19 cases patients.. Biopsy is the best treatment.. Covid 19 treatment start under hospital...

Left retroconal reaction thrombosis

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