Loss of an eye to mucormycosis following corticosteroid therapy for COVID-19

Mucormycosis is a rare, sometimes severe fungal infection that has emerged as a possible complication of COVID-19. We report a case of a non-diabetic, apparently immunocompetent patient diagnosed with rhino-orbital-cerebral mucormycosis shortly after COVID-19 treatment with dexamethasone. The patient received optimized systemic antifungal therapy and extensive surgical treatment. So far, four months after the last hospital discharge, the patient has been in good general condition. This case is a dramatic reminder that beneficial corticosteroid therapy in general inevitably carries a risk of opportunistic infection, and corticosteroid therapy for COVID-19 risks orbital-rhinocerebral mucormycosis that clinicians should watch for with vigilance.

[Deep Vein Thrombosis Prophylaxis in Patients with Traumatic Brain Injury]. / Profilaxia de Trombose Venosa Profunda em Doentes com Traumatismo Cranioencefálico.

INTRODUCTION: The risk of deep vein thrombosis is increased in patients with head trauma, but the prophylaxis against this event is confronted with the possible risk of worsening hemorrhagic injuries. In this article, we present an overview about deep vein thrombosis prophylaxis in patients with head trauma and we propose a practical protocol for clinical management of deep vein thrombosis prophylaxis. MATERIAL AND METHODS: We reviewed relevant papers cited in the Medline/PubMed, Cochrane, and Scielo databases from January 1998 to January 2014. Based on a search with the following search expression: "deep venous thrombosis and prophylaxis and traumatic brain injury", we found 44 eligible articles. Twenty-three papers were selected using criteria as published in English or Portuguese, patients in acute phase of moderate and severe traumatic brain injury and noninvasive mechanical prophylaxis or chemistry. RESULTS: Head trauma alone is a risk factor for deep vein thrombosis. The chance of deep vein thrombosis is 2.59 times higher in patients with head trauma. The prevalence of deep vein thrombosis and pulmonary embolism in patients who have suffered head trauma is 20% in the literature, reaching 30% in some studies. DISCUSSION AND CONCLUSION: Head trauma alone is a risk factor for deep vein thrombosis and pulmonary thromboembolism and the risks inherent in this disease requires methods of prevention for these complications. Clinical trials are needed to establish the efficacy of prophylaxis and the best time to start medication for deep vein thrombosis in patients with traumatic brain injury.

Introdução: O risco de trombose venosa profunda encontra-se aumentado em doentes vítimas de traumatismo cranioencefálico, mas a profilaxia da trombose venosa profunda se confronta com o possível risco de piora de lesões hemorrágicas relacionados ao traumatismo cranioencefálico. Neste artigo apresentamos uma revisão crítica do tema e propomos um protocolo de profilaxia para estes doentes.Material e Métodos: Foi realizada uma pesquisa na base de dados Medline/PubMed, Cochrane, e Scielo de janeiro de 1998 a janeiro de 2014 com a expressão de busca âÄúdeep venous thrombosis and prophylaxis and traumatic brain injuryâÄù. Foram encontrados 44 artigos usando os termos MeSH definidos. Destes foram selecionados 23 artigos, usando como critérios: publicação em inglês ou português, fase aguda do traumatismo cranioencefálico moderado e grave, profilaxia mecânica não invasiva ou química.Resultados: O traumatismo cranioencefálico é um fator de risco para trombose venosa profunda e tromboembolismo pulmonar. A chance de trombose venosa profunda é 2,59 vezes maior em doentes com traumatismo cranioencefálico. A prevalência de trombose venosa profunda e embolia pulmonar em doentes que sofreram traumatismo cranioencefálico é de 20%, podendo atingir 30% dos doentes em alguns estudos.Discussão e Conclusão: As diversas formas de traumatismo de forma isolada constituem fator de risco para trombose venosa profunda e tromboembolismo pulmonar. Ensaios clínicos são necessários para estabelecer a eficácia da profilaxia e o melhor momento de iniciar medicação para trombose venosa profunda em doentes com traumatismo craniencefálico.