Progressive chronic calvarial osteomyelitis in rhino-orbital mucormycosis associated with COVID-19

ABSTRACT

We describe two cases of extensive indolent calvarial osteomyelitis after rhino-orbital-mucormycosis in diabetic patients previously diagnosed with COVID-19. Both patients presented with acute rhino-orbital symptoms about one month after being diagnosed with COVID-19. Treatment with intravenous liposomal Amphotericin B and prompt radical surgical debridement was instituted, but calvarial osteomyelitis ensued and persisted chronically despite maintenance of antifungal therapy and partial debridement of necrotic calvarial bone. The patients were discharged to continue antifungal therapy on a day-hospital regime. After more than 8 months of treatment, they remain with radiological signs of osteomyelitis but with no symptoms or intracranial extension of the infection. Calvarial indolent osteomyelitis secondary to mucormycosis is extremely rare, and little is known regarding its treatment. We believe it can be controlled with medical treatment and partial bony debridement although more studies are necessary to better define therapy.

KEYWORDS:

• Calvarial osteomyelitis; indolent mucormycosis
• COVID-19
• craniofacial osteomyelitis
• mucormycosis

Disclosure statement

No potential conflict of interest was reported by the author(s).

Approved by the following research ethics committee

USP – Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto, USP – HCFMRP/USP (CAAE: 53,831,521.20000.5440).

Ethical approval

The report adhered to the ethical principles outlined in the Declaration of Helsinki and informed written consent was obtained from the patients.

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.