ABSTRACT
Background: Paediatric Cov-2 infections have been less severe than in adults, however some have developed a newly defined syndrome, Paediatric Inflammatory Multisystem Syndrome associated with CoV-2 (PIMS -TS). Its presentation is variable and can cause multi-system involvement. It belongs to the common spectrum of pathogen-triggered hyperinflammatory states, including atypical Kawasaki disease. Case summary: 17 year old male of Ghanaian origin, with no significant past medical history, presented with a one-week history of general malaise, fevers and sore throat. He developed severe chest pain and cardiogenic shock, with a CRP of 200, raised troponin and global hypokinesia on echocardiogram with an ejection fraction of 20%. He was positive for SARS-CoV-2 antibodies (though PCR-antigen negative at admission) and fit the criteria for myocarditis secondary to PIMS-TS. He was treated for sepsis, commenced on IV methylprednisolone and needed intubation, sedation and cardiothoracic ICU level care. On weaning sedation after 3 days, he was found to have left middle cerebral artery syndrome with NIHSS 16. CT head and CT angiogram showed a left MCA ischaemic stroke, and a thrombus in the Sylvian MCA branch. This was treated with antiplatelets. His disease markers and motor deficits improved significantly, however he has cognitive impairment and low mood. Conclusion: PIMS-TS related LVO anterior circulation infarct is rare. It necessitates urgent recognition and multi-specialty involvement as currently management is not standardised. Axial DWI (A), ADC (B) MRI demonstrate large left MCA territory infarct. Axial MRA (C) shows occlusion of the left M2 branches, signal drop-out on SWI (D).
ABSTRACT
Objective: To study the clinico-radiological presentation patterns in patients of post COVID-19 mucormycosis. Background: COVID-19 infection has been responsible for various neurological disorders like stroke, encephalitis, Guillain Barre syndrome etc. almost all over the world. The second wave of this deadly virus was followed by sudden upsurge of cases of mucormycosis in India. While the exact reason for this is still unknown, it is hypothesized to be attributed to steroid use in immunocompromised states like Diabetes Mellitus and possible contamination of intranasal oxygen with industrial oxygen. There have been various patterns of presentations of these patients to mucor units. Neurological involvement was seen in majority of these cases. This study was aimed to study clinical and radiological aspects of such patients. Design/Methods: Total 81 patients, diagnosed as mucormycosis after recovery from COVID-19 illness and who got admitted in mucor units of two tertiary care hospitals of India were included in the study. The presenting clinical features and radiological patterns of involvements were assessed. Results: Out of 81, 46(56.79%) were males and 35(43.21%) were females. Maximum 21(25.92%) patients were between 51-60 years. Most common presenting complaints were heaviness over cheek followed by headache, blurring of vision, nasal discharge, nasal crusting, chemosis of eye, decreased facial sensations and hemiparesis. MRI findings included sinusitis, cavernous sinus thrombosis, orbital cellulitis, anterior circulation infarcts and intracranial fungal abscesses. Rhino-orbital-cerebral mucormycosis was the most common pattern seen in 49(60.49%) patients followed by rhino-orbital form in 19(23.45%) patients and rhino-cerebral mucormycosis in the remaining 13(16.04%) patients. Conclusions: Mucormycosis has emerged as an important complication of COVID-19 infection after the second wave of pandemic in India. Major neurological manifestations have been seen to be associated with it. Lessons need to be learned from this mucormycosis epidemic for prevention of spread and management of this dreaded entity in other regions of the world.