Rhinocerebral mucormycosis (RCM): To study the clinical spectrum and outcome of 61 cases of RCM managed at a tertiary care center in India.

Background: Mucormycosis is a life-threatening infection of the paranasal sinuses and nasal cavities that can easily spread to the orbit and the brain. It is caused by fungi of the family Mucoraceae. We present a case series of 61 patients diagnosed and treated for rhinocerebral mucormycosis (RCM) at a single tertiary health care center. Methods: After obtaining ethical clearance, all patient files with a final diagnosis of RCM were thoroughly analyzed in departmental records and a master chart was prepared. The study evaluated the etiology, clinical spectrum, diagnosis, management, complications, and outcome at 3 months of RCM cases. Results: About 93.4% of the RCM cases were diabetic and an equal number had a past history of COVID infection. About 85.2% had received steroids for the treatment of coronavirus disease 2019 infection. The most common presentation of RCM was temporal lobe abscess (25.7%) followed by frontal lobe abscess (16.6%). At 3 months post-diagnosis, mortality in our study was 42.6%. About 26.2 % of the RCM cases had no disease, 23% had a static disease, and 8.2% had progressive disease at the end of 3 months. Conclusion: We report the largest single-center case series of RCM, comprising 61 patients. This case series underscores the importance of the early diagnosis and prompt treatment for a better prognosis for this dreadful disease. The three pillars of treatment for RCM cases include reversal of the immunosuppressive state, administration of antifungal drugs, and extensive surgical debridement. In spite of all this, mortality remains high.

Tubercular empyema a sequalae of emphysematous pyelonephritis with porous diaphragm syndrome and its successful management: A case report.

INTRODUCTION: Emphysematous pyelonephritis (EP) is a life-threatening renal disease requiring early and immediate therapy. EP resulting in tubercular empyema is unusual, with no reports to date. PRESENTATION OF CASE: A 50-year-old female in sepsis diagnosed with diabetes mellitus on insulin presented with recurrent abdominal pain radiating to the left side of her back for one month and recurrent episodes of vomiting and fever for one week. Her contrast-enhanced computed tomography showed emphysematous pyelonephritis (EP), ruptured splenic abscess, disrupted and eventrated left diaphragmatic lining, pleuroperitoneal communication, and a left empyema. Genexpert studies for pleural pus revealed Mycobacterium tuberculosis. Her deteriorating condition required surgical intervention in the form of decortication, sterilization of the thoracic cavity, and composite mesh placement for the diaphragmatic porous syndrome. CONCLUSION: This case report demonstrates the rare and aggressive presentation of EP, its sequelae, and successful management with composite mesh to prevent recurrent intrathoracic infection secondary to porous diaphragm syndrome.