A case series of mucormycosis after covid infection in two hospitals - 21/06/22

Doi : 10.1016/j.jormas.2022.06.003

Hélder D.D. Martins ^a,^⁎ , Arturo Rangel Pares ^b, Armando Torres Martínez ^c, Rogelio Alberto Ponce Guevara ^d, Sirius D. Inaoka ^e, Davi F.N. Costa ^e, Carlson B. Leal ^e, Ciro D. Soares ^f, Alexandre R. da Paz ^g, Danyel E. da C. Perez ^h, Ricardo Martínez Pedraza ^b, Paulo R.F. Bonan ^a
^a Post Graduation Program in Dentistry, Universidade Federal da Paraíba (UFPB), Campus I - Cidade Universitária, João Pessoa, Paraíba 58033-455, Brazil
^b Universidad Autónoma de Nuevo León, Mexico
^c Oral and Maxillofacial Surgeon, Benemérita Universidad Autonoma de Puebla, Mexico
^d Oral and Maxillofacial Surgeon, School of Dentistry, Torreon Unit, Universidad Autonoma de Coahuila, Mexico
^e Oral and Maxillofacial Surgeon, Hospital Universitário Lauro Wanderley, Universidade Federal da Paraíba, João Pessoa, Paraíba, Brazil
^f Immunohistochemistry and Histopathology Group / International Research Group, Natal, Brazil
^g Pathological Anatomy Service, Hospital Universitário Lauro Wanderley, Universidade Federal da Paraíba, João Pessoa, Paraíba, Brazil
^h Department of Clinical and Preventive Dentistry, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil

^⁎Corresponding author.

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Highlights

•	COVID-19 still presents uncommon oral manifestations.
•	In pandemic period, lesions with unusual presentations should be suspected of being associated with COVID-19 infection.
•	As the pandemic endures, it is crucial for doctors and dentists to be aware of this presentation of mucormycosis associated to COVID 19.
•	Uncontrolled diabetes, the excessive us of corticosteroids, prolonged neutropenia, hemopoietic malignancies are the most common causes attributed to the rise of mucormycosis in COVID-19.

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Abstract

This paper aims to discuss clinical aspects of mucormycosis. This case series was conducted in two services, comprising six mucormycosis cases during COVID-19 pandemic. About gender, there are 4 (66.7%) males and 2 (33.3%) females with mean age (48.7 ± 9.4) years. All cases presented complaints of pain and swelling in oral cavity and had an aggressive clinical presentation. Five patients had diabetes and one had a nasal non-Hodgkin lymphoma. Histologically, large, branched, hyphae associated with necrotic areas were observed, confirming microscopically such as mucormycosis through PAS and GMS stains. In four cases, treatment consisted in surgical debridement associated with antifungal therapy. All patients were submitted to debridement and received antifungal treatment (amphotericin B). Five patients were followed up without clinical recurrence, but unfortunately one patient died. Diagnosis of mucormycosis should be early because it is related to high mortality. The treatment consists of surgical debridement associated with antifungal therapy.

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Keywords : Coronavirus, Mucormycosis, Infections, Oral diagnosis