ABSTRACT
Rhinocerebral mucormycosis has emerged as a common coinfection in coronavirus disease 2019 (COVID-19) patients during the convalescence period. Frequent spread of disease from sinonasal mucosa to bone, neck spaces, orbit, and brain occurs along the perivascular/perineural routes or through direct invasion. Brain involvement represents severe manifestation and is often associated with poor functional outcomes and high mortality rates. Magnetic resonance imaging (MRI) is the modality of choice for the intracranial assessment of disease severity in mucormycosis. Early and accurate identification of intracranial extension is imperative to improve survival rates. With this pictorial essay, we aim to familiarize the readers with the cross-sectional imaging features of intracranial complications of mucormycosis. The radiological details in this essay should serve as a broad checklist for radiologists and clinicians while dealing with this fulminant infection.
ABSTRACT
Background: SARS-CoV-2 infection, in the most severe cases, can cause bilateral pneumonia and respiratory failure. In these cases, therapy is based on the use of antiviral drugs, immunosuppressants (in order to reduce the cytokine-mediated inflammatory response),oxygen and sometimes non-invasive mechanical ventilation (NIV).We describe 2 cases of severe bacterial infections probably favored by the immunosuppressive therapy. Description of the cases: A 63-year-old man with no history of significant medical conditions and an 86-year-old man with history of ischemic heart disease treated with PTCA+DES, were both hospitalized for severe bilateral SARS-CoV-2 pneumonia and treated with NIV associated with high-dose steroids (Dexamethasone 8 mg IV per day). After the resolution of the pulmonary infection, the first one developed a Pneumocystis jirovecii pneumonia with the need for re-hospitalization and treatment with trimethoprim-sulfamethoxazole;the second one developed a methicillin-resistant Staphylococcus aureus (MRSA) endocarditis with infarct lesions caused by septic emboli in brain and splenic area, with subsequent clinical aggravation and death. Conclusions: The SARS-CoV-2 pneumonia treatment is based on combined use of NIV and anti-inflammatory, antiviral and immunosuppresive drugs: it is important to minimize duration of treatment because it may lead to the development of serious complications like septic states (even by opportunistic pathogens) that are lifethreatening for the patients.