ABSTRACT
Background: Hydatid disease is a tapeworm parasitic infection caused by Echinococcus granulosus that commonly affects the liver and lungs during its life cycle in the human body. Orbital involvement is a very rare occurrence and isolated orbital Echinococcosis is extremely rare. Case Presentation: A 60-year-old female Eritrean woman presented with 3-month history of painless protrusion of the left eye. Physical examination showed significantly decreased visual acuity of the left eye, left eye proptosis, and papilledema. Laboratory investigations were normal and orbital CT scan examination was suggestive of orbital hydatid cyst. After giving two weeks course of oral Albendazole, anterior orbitotomy and cyst excision was done. Post-op biopsy was conclusive of orbital hydatid cyst. She had mild lid swelling and adduction deficit on her post-operative follow-up. Subsequent longer duration of follow-up of the patient was not possible since the patient relocated back to Eritrea. Conclusion: Orbital hydatid cyst is an extremely rare presentation of human Echinococcus granulosus infection. However, it should be considered one of the differential diagnoses among patients living in an endemic area and presenting with proptosis of the eye. A preoperative course of anthelmintic followed by surgical excision of the cyst is the definitive management.
ABSTRACT
Background: There has been a rise in secondary invasive fungal infections reported in COVID-19 patients globally. We report the first published case of COVID-19 associated rhino-orbital-cerebral mucormycosis in Africa in a newly diagnosed diabetic female who presented with diabetic ketoacidosis (DKA) and discuss the prevalence and risk factors of fungal co-infection with the clinical presentation, diagnosis, and management of mucormycosis in COVID-19. Case Presentation: A 39 years old female patient was admitted to ICU with a diagnosis of severe COVID-19 and newly diagnosed diabetes mellitus (DM) with DKA based on HgbA1c of 13.8% and positive RT-PCR. The patient was treated with dexamethasone in line with evidence in the RECOVERY trial and developed right facial and orbital swelling on her second hospital day. Brain MRI showed characteristic peri-sinonasal invasion with central nervous system (CNS) involvement, features suggestive of invasive fungal infection. Despite all medical and surgical treatments including liposomal amphotericin B and debridement, the patient died within 7 days of symptom onset. Conclusion: Clinicians should be aware of the potential for Rhino-Orbital-Cerebral Mucormycosis (ROCM) as a complication of COVID-19, especially in steroid taking diabetics who develop periorbital swelling and sinusitis. Timely diagnosis and multidisciplinary treatment are very critical.
