Emergence of Rhino-Orbito-Cerebral Mucormycosis in Peru: Impact of the COVID-19 Pandemic.

Introduction Mucormycosis is an invasive fungal infection caused by Mucorales that has been increasingly recognized over the years, particularly during the COVID-19 pandemic. Nevertheless, in Peru, there has been limited research on this disease. This study seeks to provide insights into the demographics, clinical presentations, treatment, and outcomes of patients with mucormycosis, before and during the COVID-19 pandemic. Materials and methods We conducted a retrospective case series by reviewing the medical records of Peruvian patients hospitalized at a referral medical center between 2017 and 2021. The selection criteria included patients aged 18 years or older with clinical features of rhino-orbito-cerebral mucormycosis supported by radiological imaging. We extracted data related to risk factors for mucormycosis infection, clinical presentation, management, and hospitalization. Data analysis was performed using Stata software (StataCorp LLC, College Station, Texas, USA) to compare patient groups before and during the COVID-19 pandemic. Results Nineteen cases met our selection criteria: 11 men and eight women with an average age of 57.6 ± 10.6 years. All 19 patients had type 2 diabetes mellitus as comorbidity, with 13 cases exhibiting uncontrolled diabetes. Six patients presented before the COVID-19 pandemic, while 13 during its course. Within the group of patients diagnosed during the pandemic, nine were diagnosed with SARS-CoV-2 infection. Regarding the site of mucormycosis infection, the paranasal sinuses were predominantly involved. Survival analysis indicated that patients who developed mucormycosis during the COVID-19 pandemic, those with uncontrolled diabetes, or those who did not undergo surgery had lower probabilities of survival. Conclusion Mucormycosis is a rare infection associated with high mortality and morbidity with increased frequency during the COVID-19 pandemic. Early diagnosis, timely administration of antifungal treatment, surgery, and effective management of comorbidities can have life-saving implications. Unfortunately, despite the availability of various diagnostic tests and less toxic antifungal options such as liposomal amphotericin-B, such resources are not accessible in Peru's national hospitals.

Síndrome DRESS durante tratamiento antituberculoso / Antituberculous drug-induced Dress syndrome

Se presenta el caso de un varón de 26 años que cursa con erupción cutánea toracoabdominal, eosinofilia, linfocitosisatípica, hepatoesplenomegalia y compromiso de la función hepática, secundario al inicio de terapia antituberculosa. El paciente evoluciona favorablemente con la suspensión de las drogas antituberculosas y el uso de antihistamínicos y corticoides.

During tuberculosis therapy, a 26 year-old male patient developed rash on chest and abdomen, eosinophilia, atypicallymphocytosis, liver and spleen enlargement and severeliver dysfunction. After tuberculosis therapy withdrawal and the treatment with antihistamines and steroids, the patient showed total improvement.

Criptococosis meníngea en una paciente con lupus eritematoso sistemático / Cryptococcal meningitis in patient with systemic lupus erythematosus

Paciente mujer de 39 años, con antecedentes de lupus eritematoso sistemático y en tratamiento inmunosupresor con prednisona y ciclofosfamida. Consultó por cefalea intensa y vómitos de contenido alimentario. Las funciones vitales fueron normales, con obesidad central y facies cushingoide. En el examen del líquido cefalorraquídeo se evidenció pleocitosis, hiperproteinorraquia, hipoglucorraquia, el test de tinta china y cultivo positivos para Crytococcus neoformans. La paciente recibió tratamiento con anfotericina B durante 10 semanas, hubo uno recaída temprana y necesitando la colocación de una válvula lumbo-peritoneal.

A 39-year-old female patient, with systemic lupus erythematosus, under inmunosuppressive therapy with prednisone and cyclophosphamide. She consulted because of severe headache and vomiting of food content for one day duration. The vital signs were normal, with central obesity and cushingoid face. The cerebrospinal fluid examination revealed plecytosis, high protein level, low glucose level and the india ink test and culture were positives for Crytococcus neoformans. The patient was treated with amphotericin B for 10 weeks, there was an early relapse and it was placed a lumbo-peritoneal shunt.