Spectrum of orbital fat necrosis in rhino-orbital-cerebral mucormycosis in post-COVID-19 patients.
Humans
Mucormycosis
/ diagnosis
Male
Retrospective Studies
Female
COVID-19
/ complications
Adult
Eye Infections, Fungal
/ diagnosis
Middle Aged
Orbital Diseases
/ diagnosis
Fat Necrosis
/ diagnosis
Tomography, X-Ray Computed
SARS-CoV-2
India
/ epidemiology
Orbit
/ diagnostic imaging
Young Adult
Paranasal Sinus Diseases
/ diagnosis
Debridement
/ methods
Aged
Journal
Indian journal of ophthalmology
ISSN: 1998-3689
Titre abrégé: Indian J Ophthalmol
Pays: India
ID NLM: 0405376
Informations de publication
Date de publication:
01 Oct 2024
01 Oct 2024
Historique:
received:
27
09
2023
accepted:
17
05
2024
medline:
27
9
2024
pubmed:
27
9
2024
entrez:
27
9
2024
Statut:
ppublish
Résumé
Rhino-orbital-cerebral mucormycosis (ROCM) is the most common presentation of mucormycosis. Sinonasal-orbital debridement with exenteration is a life-saving procedure in ROCM patients in view of severe involvement of sinuses and the eyeball. Following the second wave of coronavirus disease 2019 (COVID-19), there was a massive surge in mucormycosis cases in India in post-COVID-19 patients. Of over 300 cases of mucormycosis admitted in our hospital, many underwent exenteration and these specimens were evaluated histopathologically, where fat necrosis was found to be a prominent finding. The spectrum of fat necrosis in ROCM in orbital fat has not been described in literature. Hence, we sought to evaluate the significance and spectrum of orbital fat necrosis in ROCM. This 3-month retrospective study included 15 cases of ROCM which underwent exenteration. Clinical data, radiologic details, and histopathologic findings were tabulated. Sections were also subjected to Periodic acid Schiff (PAS) and Gomori's methenamine silver (GMS) stains for confirming the fungus. All 15 cases showed fat stranding on computed tomography (CT) scan. On histopathologic examination, various tissue reaction patterns observed included acute/chronic inflammatory infiltrate, suppurative granulomas with giant cells, coagulative and fat necrosis, broad aseptate fungal hyphae with or without angioinvasion, and neural invasion. Fungal hyphae were confirmed with PAS and GMS stains. The spectrum of fat necrosis observed in all the cases included 1) acute necrotizing fat necrosis, 2) ghost adipocytes with or without saponification, and 3) crystalline/gouty fat necrosis. Fat necrosis is a significant finding in ROCM, both on CT scan and histopathology. All three patterns of fat necrosis may be observed simultaneously in a case of ROCM.
Identifiants
pubmed: 39331438
doi: 10.4103/IJO.IJO_2623_23
pii: 02223307-202472100-00018
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1478-1482Informations de copyright
Copyright © 2024 Copyright: © 2024 Indian Journal of Ophthalmology.
Références
Ribes JA, Vancouver-Sams CL, Baker DJ. Zygomycetes in human disease. Clin Microbiol Rev 2000;13:236–301.
Hibbett DS, Binder M, Bischoff JF, Blackwell M, Cannon PF, Eriksson OE, et al. A higher-level phylogenetic classification of the Fungi. Mycol Res 2007;111:509–47.
Wirth F, Perry R, Eskenazi A, Schwalbe R, Kao G. Cutaneeous Mucormycosis with subsequent visceral dissemination in a child with neutropenia: A case report and review of the paediatric literature. J Am Acad Dematol 1996;35:336–41.
Spellberg B, Edwards J Jr, Ibrahim A. Novel perspectives on mucormycosis: Pathophysiology, presentation, and management. Clin Microbiol Rev 2005;18:556–69.
Ingram PR, Suthananthan AE, Rajan R, Pryce TM, Sieunarine K, Gardam DJ, et al. Cutaneous mucormycosis and motor vehicle accidents: Findings from an Australian case series. Med Mycol 2014;52:819–25.
Castrejón‐Pérez AD, Welsh EC, Miranda I, Ocampo‐Candiani J, Welsh O. Cutaneous mucormycosis. An Bras Dermatol 2017;92:304–11.
Singh AK, Singh R, Joshi SR, Misra A. Mucormycosis in COVID-19: A systematic review of cases reported worldwide and in India. Diabetes Metab Syndr 2021;15:102–46.
Sugar AM. In: Mandell GL, Bennett JE, Dolin R, editors. Mandell, Douglas, and Bennett’s principles and Practice of Infectious Diseases. 5th ed. New York, USA: Churchill Livingstone; 2000.
Kauh CY, Nelson CC. Diagnosis and management of orbital mucormycosis. Ophthalmic pearls 2014;37–9.
Sharma NC. India reports 40,854 cases of black fungus so far. Mint. 2021. Available from: https://www.livemint.com/news/india-records-over-40k-cases-of-mucormycosis-11624875874985.html.
Anonymous. Over 1,650 black fungus cases in Delhi. The Economic Times. 2021. Available from: https://economictimes.indiatimes.com/news/india/over-1650-black-fungus-cases-in-delhi/articleshow/84388980.cms?utm_source=contentofinterest and utm_medium=text and utm_campaign=cppst.
Dutt A. 760 black fungus patients still being treated in Delhi hospitals. Hindustan Times. 2021. Available from: https://www.hindustantimes.com/cities/delhi-news/760-black-fungus-patients-still-being-treated-in-delhi-hospitals-101625248850429.html.
Badin JD, Baker C, Simmons BJ, Yan S, Zug KA. The elusive nature of mucormycosis in an immunocompetent host and the role of a dermatology consult. Clin Case Rep 2019;7:2187–9.
Chicharro P, Gallo E, Dauden E, Fraga J, Velasco ML. Necrotizing panniculitis secondary to primary cutaneous localized mucormycosis. J Dermat Cosmetol 2021;5:27–9.
Albert DM, Lesser RL, Cykiert RC, Zakov N. Orbitofacial mucormycosis with unusual pathological features. Br J Ophthalmol 1979;63:699–703.
Dinesh, Prasad U, Suman SK, Kumari M, Waghmare V. The radiological spectrum of rhino-oculo-cerebral mucormycosis. Cureus 2023;15:e40932.
Grech R, Cornish KS, Galvin PL, Grech S, Looby S, O’Hare A, et al. Imaging of adult ocular and orbital pathology--A pictorial review. J Radiol Case Rep 2014;8:1–29.
Thornton E, Mendiratta ML, Siewert B, Eisenberg RL. Patterns of fat stranding. Am J Roentgenol 2011;197:W1–4.
Fatterpekar GS, Mukherji S, Arbealez A, Maheshwari S, Castillo M. Fungal diseases of the paranasal sinuses. Semin Ultrasound CT MR 1999;20:391–401.
Badiee P, Arastefar A, Jafarian H. Comparison of histopathological analysis, culture and polymerase chain reaction assays to detect mucormycosis in biopsy and blood specimens. Iran J Microbiol 2013;5:406–10.
Godinho G, Abreu I, Alves G, Vaz R, Leal V, Carvalho AC, et al. Orbital apex syndrome due to orbital mucormycosis after teeth infection: A successful case report. Case Rep Ophthalmol 2021;12:110–5.
Requena L, Sitthinamsuwan P, Santonja C, Fernandez-Figueras MT, Rodrigez-Paralto JL, Argenyi Z, et al. Cutaneous and mucosal mucormycosis mimicking pancreatic panniculitis and gouty panniculitis. J Am Acad Dermatol 2012;66:975–84.
Velasco ML, Fernandez-Figueras MT. A practical approach to clinic-pathological diagnosis of panniculitis. Diagn Histopathol 2020;27:34–41.
Gupta P, Saika UN, Arora S, De D, Radotra BD. Panniculitis: A dermatopathologist’s perspective and approach to diagnosis. Indian J Dermatopathol Diagn Dermatol 2016;3:29–41.
Tsushima Y, Nishizawa H, Tochino Y, Nakatsuji H, Sekimoto R, Nagao H. Uric acid secretion from adipose tissue and its increase in obesity. J Biol Chem 2013;288:27138–49.
Kapoor AG, Vijitha VS, Mittal R, Satyanarayana TVS. Intra-orbital fat necrosis following transcaruncular orbitotomy mimicking a surgical site infection: A case report. Saudi J Ophthalmol 2022;35:350–2.