Concluded Case

Mucormycosis complications

This non- covid pt with uncontrolled diabetes with palatal ulcers and sino rhinal mucosal swelling which on tissue biopsy confirmed Mucormycosis. Presented with multiple cranial nerve palsy, complete painful ophthalmoplegia including ipsilateral facial palsy and multiple embolic infarcts from left ICA occlusion

(Edited)

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Concluded answer

Absolutely it is a c/o nasocerebral MUCORMYCOSIS as pt is diabetic hence prone to fungal infection she is covid negative suggest not every case of MUCORMYCOSIS will be covid only Yes covid positive diabetic pt is predisposed to fungal infection Here she has cerebral infarct hence needs to be on inj amphotercinB liposomal urgently Inj piperacillin+inj tazobactum Inj Ceftriaxozone Rest of supportive treatment with the advice of neurologist and physician Anticoagulants inj enoxiparum or inj LMWH or inj clexan to be started

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Absolutely it is a c/o nasocerebral MUCORMYCOSIS as pt is diabetic hence prone to fungal infection she is covid negative suggest not every case of MUCORMYCOSIS will be covid only Yes covid positive diabetic pt is predisposed to fungal infection Here she has cerebral infarct hence needs to be on inj amphotercinB liposomal urgently Inj piperacillin+inj tazobactum Inj Ceftriaxozone Rest of supportive treatment with the advice of neurologist and physician Anticoagulants inj enoxiparum or inj LMWH or inj clexan to be started

Thanx dr Pushkar ji Bhomia
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? RHINO CEREBRAL .. MUCORMYCOSOSIS .. WITH .. UNCONTROLLED DIABETES .. MANAGEMENT .. STRICT GLYCEMIC CONTROL WITH ANTIDIABETIC MANAGEMENT .. WITH .. INSULIN .. OHA .. ENDOCRINOLOGIST OPINION .. ANTIFUNGAL MANAGEMENT WITH .. MULTIFACETED APPROACH .. INJECTION .. AMFOCAN .. IV .. FLUCONAZOLE .. ORAL ANTIFUNGAL MEDICATIONS.. SURGICAL INTERVENTION.. NEUROLOGISTS & EYE SURGEONS.. OPINION ..

Tnx Dr Shivraj Agarwal sir
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MUCORMYCOSIS STARTS AS KIND OF MAXILLARY SINUSITIS INVOLEMENT OF FRONTAL AND ETHEMIOD SINDUSES SO IF PT HAS GOOD NASAL IMMUNITY PT DOES NOT GET BLACK FUNGUS FROM NOSE ORBIT IS INVOLVED IN THE FORM OF PERIORBITAL ECHMOSES PROOTOSIS OPHTHALMOPLEGIA VISUAL LOSS INVOLEMENT OF C N S AND BRAIN E INVOLVEMENT OF LUNGS

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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Mucormycosis leading to various complications ,while uncontrolled DM is associated with stroke,is there any other risk factors? What about BP? Is pt in AF? What about the cause of facial palsy

Non hypertensive, I forgot to mention.
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Absolutely.. Nascocerbral infection... Starting.. Diabetic patients.. Treatment of diabetic.. Medication starting diabetic protocol.... For eye.. Moxifloxacin keto eye drops QD 7 days.. Lubricant eyes drops QD 7 days.. Antinflammatory eyes drops QD 7 days... Cold compress 3 times daily 7 days.. Tab Itraconazole 200 mg 15 days.. Tab salnac-Sp sos pain'forehead.. Cover the eyes of dust particles UV light Sun light cover eyes by Black Google's need... Tab cipflox use.. Tab methotrexate 20 mg od 15 days.. Clean eyes regularly saline water solutions... Rest at home 7 days under hospital... Don't scrubbing and stress left eye.. Neosporin eyes drops BD 7 days...

Thanks doctor
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Mucormycosis With CNS & Cranial nerves involved Strict control of diabetes Inj Amphotrecin B I V Tab Candid 200 mg o d Ref patient to neurosurgeon/Eye specialist for surgery & cardiologist for evaluation and treatment of cardiac disease

Rhinocerebral Mucormycosis with uncontrolled diabetes with complication of multiple cerebral infarcts (lt side)with lt ophthalmoplegia and multiple cranial nerve nerve palsies.A very difficult case to treat. A strict control of diabetes is required with Insulin IV Amphotericin LMW heparin Proper eye and ent consultation Proper nutrition and physiotherapy and care. Inspite of best treatment prognosis is guarded as mortality is >50%.

Non covid patients contracting black fungus mucormycosis is great fear we must plan accordingly , mucormycosis is proving grave danger to covid patients

Sinonasal Mucormycosis surgery 1 mg Amphotericin-B in 200 ml of 5% dextrose was given. Every alternate day kidney function and serum electrolytes were monitored. Nasal endoscopy was done daily and gelfoam soaked with Amphotericin-B was kept locally at the surgically debrided area. Follow-up was done every week for first 3 weeks and then every month for 6 months.

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