Invasive pulmonary and sino-orbital mucor mycosis in patient with SARS-Cov-2 infection with diabetic ketoacidosis

Patients with Severe acute respiratory syndrome coronavirus-2 (SARS-Cov-2) are susceptible for developing fungal infection due to uncontrolled diabetes or immunosuppression. A 46 years male presented with diabetic ketoacidosis, respiratory failure with peri orbital blackish discoloration with SARS-Cov-2 positive report. Computed tomography (CT) chest was suggestive of perihilar ground glass opacity and multiple thick-walled cavities. Left nasal cavity scrapings revealed hyaline aseptate hyphae and growth of Rhizopus arrhizus. Patient was initially managed conservatively with liposomal amphotericin B but later underwent orbital exenteration and finally succumbed. We want to emphasize higher mortality and aggressive management of mucor mycosis when it occurs with SARS-Cov-2 as a concurrent illness.

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Tubelight Adrenals in Diabetic Ketoacidosis

Clinical Practice and Cases in Emergency Medicine ◽

10.5811/cpcem.2020.6.47617 ◽

2020 ◽

Vol 4 (3) ◽

pp. 482-484

Author(s):

Prakrati Yadav ◽

Akhilesh Kumar ◽

Rohit Mathur ◽

Pawan Garg ◽

Maya Gopalakrishnan ◽

...

Keyword(s):

Computed Tomography ◽

Acute Pancreatitis ◽

Diabetic Ketoacidosis ◽

Poor Prognosis ◽

Abdominal Imaging ◽

Case Presentation ◽

Aggressive Management ◽

Hypoperfusion Complex

Case Presentation: We report a patient with the triad of diabetic ketoacidosis, hypertriglyceridemia, and acute pancreatitis associated with computed tomography hypoperfusion complex and adrenal hyperdensity on abdominal imaging – an association not previously reported in diabetic ketoacidosis. Discussion: Presence of computed tomography hypoperfusion complex with hyperdense ‘Tubelight adrenals’ in a patient with diabetic ketoacidosis is associated with poor prognosis and thus serves to guide clinicians towards early and aggressive management.

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Efficacy of chest X-ray in the diagnosis of COVID-19 pneumonia: comparison with computed tomography through a simplified scoring system designed for triage

Egyptian Journal of Radiology and Nuclear Medicine ◽

10.1186/s43055-021-00541-x ◽

2021 ◽

Vol 52 (1) ◽

Author(s):

Akın Çinkooğlu ◽

Selen Bayraktaroğlu ◽

Naim Ceylan ◽

Recep Savaş

Keyword(s):

Computed Tomography ◽

Intensive Care ◽

Intensive Care Units ◽

Scoring System ◽

Imaging Modality ◽

Ground Glass Opacity ◽

Initial Presentation ◽

X Ray ◽

Chest X Ray

Abstract Background There is no consensus on the imaging modality to be used in the diagnosis and management of Coronavirus disease 2019 (COVID-19) pneumonia. The purpose of this study was to make a comparison between computed tomography (CT) and chest X-ray (CXR) through a scoring system that can be beneficial to the clinicians in making the triage of patients diagnosed with COVID-19 pneumonia at their initial presentation to the hospital. Results Patients with a negative CXR (30.1%) had significantly lower computed tomography score (CTS) (p < 0.001). Among the lung zones where the only infiltration pattern was ground glass opacity (GGO) on CT images, the ratio of abnormality seen on CXRs was 21.6%. The cut-off value of X-ray score (XRS) to distinguish the patients who needed intensive care at follow-up (n = 12) was 6 (AUC = 0.933, 95% CI = 0.886–0.979, 100% sensitivity, 81% specificity). Conclusions Computed tomography is more effective in the diagnosis of COVID-19 pneumonia at the initial presentation due to the ease detection of GGOs. However, a baseline CXR taken after admission to the hospital can be valuable in predicting patients to be monitored in the intensive care units.

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Chest computed tomography imaging features in patients with coronavirus disease 2019 (COVID-19)

Journal of International Medical Research ◽

10.1177/03000605211010631 ◽

2021 ◽

Vol 49 (5) ◽

pp. 030006052110106

Author(s):

Hoda Salah Darwish ◽

Mohamed Yasser Habash ◽

Waleed Yasser Habash

Keyword(s):

Computed Tomography ◽

Intermediate Phase ◽

Early Stage ◽

Lower Lobe ◽

Ground Glass Opacity ◽

Intermediate Stage ◽

Mediastinal Lymphadenopathy ◽

Imaging Features ◽

Stage Disease ◽

Bilateral Lesions

Objective To analyze computed tomography (CT) features of symptomatic patients with coronavirus disease 2019 (COVID-19). Methods Ninety-five symptomatic patients with COVID-19 confirmed by reverse-transcription polymerase chain reaction from 1 May to 14 July 2020 were retrospectively enrolled. Follow-up CT findings and their distributions were analyzed and compared from symptom onset to late-stage disease. Results Among all patients, 15.8% had unilateral lung disease and 84.2% had bilateral disease with slight right lower lobe predilection (47.4%). Regarding lesion density, 49.4% of patients had pure ground glass opacity (GGO) and 50.5% had GGO with consolidation. Typical early-stage patterns were bilateral lesions in 73.6% of patients, diffuse lesions (41.0%), and GGO (65.2%). Pleural effusion occurred in 13.6% and mediastinal lymphadenopathy in 11.5%. During intermediate-stage disease, 47.4% of patients showed GGO as the disease progressed; however, consolidation was the predominant finding (52.6%). Conclusion COVID-19 pneumonia manifested on lung CT scans with bilateral, peripheral, and right lower lobe predominance and was characterized by diffuse bilateral GGO progressing to or coexisting with consolidation within 1 to 3 weeks. The most frequent CT lesion in the early, intermediate, and late phases was GGO. Consolidation appeared in the intermediate phase and gradually increased, ending with reticular and lung fibrosis-like patterns.

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Fibrotic progression and radiologic correlation in matched lung samples from COVID-19 post-mortems

Virchows Archiv ◽

10.1007/s00428-020-02934-1 ◽

2020 ◽

Cited By ~ 3

Author(s):

Emanuela Barisione ◽

Federica Grillo ◽

Lorenzo Ball ◽

Rita Bianchi ◽

Marco Grosso ◽

...

Keyword(s):

Computed Tomography ◽

Diffuse Alveolar Damage ◽

Ground Glass Opacity ◽

Post Mortem ◽

Mechanically Ventilated ◽

Illness Duration ◽

Transbronchial Lung Cryobiopsy ◽

Histopathologic Analysis ◽

Lung Lobes

Abstract Data on the pathology of COVID-19 are scarce; available studies show diffuse alveolar damage; however, there is scarce information on the chronologic evolution of COVID-19 lung lesions. The primary aim of the study is to describe the chronology of lung pathologic changes in COVID-19 by using a post-mortem transbronchial lung cryobiopsy approach. Our secondary aim is to correlate the histologic findings with computed tomography patterns. SARS-CoV-2-positive patients, who died while intubated and mechanically ventilated, were enrolled. The procedure was performed 30 min after death, and all lung lobes sampled. Histopathologic analysis was performed on thirty-nine adequate samples from eight patients: two patients (illness duration < 14 days) showed early/exudative phase diffuse alveolar damage, while the remaining 6 patients (median illness duration—32 days) showed progressive histologic patterns (3 with mid/proliferative phase; 3 with late/fibrotic phase diffuse alveolar damage, one of which with honeycombing). Immunohistochemistry for SARS-CoV-2 nucleocapsid protein was positive predominantly in early-phase lesions. Histologic patterns and tomography categories were correlated: early/exudative phase was associated with ground-glass opacity, mid/proliferative lesions with crazy paving, while late/fibrous phase correlated with the consolidation pattern, more frequently seen in the lower/middle lobes. This study uses an innovative cryobiopsy approach for the post-mortem sampling of lung tissues from COVID-19 patients demonstrating the progression of fibrosis in time and correlation with computed tomography features. These findings may prove to be useful in the correct staging of disease, and this could have implications for treatment and patient follow-up.

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Respiratory failure in a diabetic ketoacidosis patient with severe hypophosphatemia

Annals of Pediatric Endocrinology & Metabolism ◽

10.6065/apem.2018.23.2.103 ◽

2018 ◽

Vol 23 (2) ◽

pp. 103-106 ◽

Cited By ~ 8

Author(s):

Han Saem Choi ◽

Ahreum Kwon ◽

Hyun Wook Chae ◽

Junghwan Suh ◽

Duk Hee Kim ◽

...

Keyword(s):

Respiratory Failure ◽

Diabetic Ketoacidosis

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Respiratory Failure in the Course of Treatment of Diabetic Ketoacidosis

Clinical Diabetes ◽

10.2337/diaclin.32.1.28 ◽

2014 ◽

Vol 32 (1) ◽

pp. 28-31

Author(s):

A. Regmi ◽

N. K. Konstantinov ◽

E. I. Agaba ◽

M. Rohrscheib ◽

R. I. Dorin ◽

...

Keyword(s):

Respiratory Failure ◽

Diabetic Ketoacidosis

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A RARE CASE MORTALITY OF DIABETIC KETOACIDOSIS- CEREBRAL EDEMA WITH TONSILLAR HERNIATION- A CONTRADICTORY OPINION.IS SODIUM BICARBONATE A REAL CULPRIT?

10.36106/1503265 ◽

2021 ◽

pp. 8-10

Author(s):

Sruthi P ◽

Manzoor Sharieff M ◽

Prasanth Kumar P ◽

Vishnu priya V ◽

Nagarajan N ◽

...

Keyword(s):

Diabetic Ketoacidosis ◽

Cerebral Edema ◽

Hydrogen Exchange ◽

Ketone Bodies ◽

Acetoacetic Acid ◽

Tonsillar Herniation ◽

Sodium Hydrogen ◽

Uncontrolled Diabetes ◽

Case Mortality

Diabetic ketoacidosis (DKA) is the most common complication seen in uncontrolled diabetes mellitus. DKA is most commonly seen with patients of type 1 diabetes. Depletion of Insulin leads to high blood sugars which in turn leads osmotic diuresis, production of ketone bodies i.e, βhydroxybutyric acid and acetoacetic acid, dysregulation of sodium hydrogen exchange mechanism[2]. As a consequence to the above stated mechanisms, cerebral edema has been documented as a fatal complication in DKA. Mortality documented due to cerebral edema is 21-25%[4].

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Treatment of Rhinocerebral Mucormycosis by Combination of Endoscopic Sinus Debridement and Amphotericin B

American Journal of Rhinology ◽

10.1177/194589240101500508 ◽

2001 ◽

Vol 15 (5) ◽

pp. 327-331 ◽

Cited By ~ 26

Author(s):

Isam Alobid ◽

Manuel Bernal ◽

Carlos Calvo ◽

Isabel Vilaseca ◽

Juan Berenguer ◽

...

Keyword(s):

Diabetes Mellitus ◽

Computed Tomography ◽

Histopathological Examination ◽

Ct Scanning ◽

Definitive Diagnosis ◽

Immunocompromised Patients ◽

Imaging Procedures ◽

Rhinocerebral Mucormycosis ◽

Uncontrolled Diabetes ◽

Mucosal Necrosis

Rhinocerebral mucormycosis (RCM) is an aggressive fungal infection with a high mortality rate. It frequently develops in patients with uncontrolled diabetes mellitus or immunocompromised patients. RCM typically presents in a rapidly fulminant manner with headache, fever, mucosal necrosis, and ophthalmic symptoms. Although the definitive diagnosis is achieved by histopathological examination, computed tomography (CT) scanning and magnetic resonance (MR) are the best imaging procedures in early diagnosis to assess the extent of the disease.

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