{"title":"分离的下运动神经元面神经麻痹是COVID-19相关眼眶毛霉菌病患者的表现:一项回顾性观察研究","authors":"A. R","doi":"10.23880/oajo-16000270","DOIUrl":null,"url":null,"abstract":"Purpose: The main purpose of this study is to emphasize that isolated facial nerve involvement can be the first presenting symptom in patients suspected of COVID-associated Mucormycosis (CAM). Methods: This study is a retrospective observational study conducted at a tertiary care referral center which included patients with a history of CAM, who presented with isolated facial nerve palsy as initial presentation between March 2021 to March 2022 along with their follow-up. All the patients were managed with combined modality treatment with antifungal therapy and debridement of the necrotic tissue and fungal debris. Results: There were 184 eyes of 148 patients diagnosed with CAM. All patients developed rhino-orbital mucormycosis (ROM) following the COVID-19 infection and the duration between diagnosis of COVID-19 and ROM was 36±23 days. 42(28%) patients presented with isolated Facial Nerve Palsy (FNP) as the initial presentation. The mean age was 48.5 years (range 38 to 67years) with a male predominance of 29 (69%). All were unilateral cases and were of Lower motor neuron type presentation. All the patients (100%) were treated with systemic Liposomal amphotericin-B and sinus debridement. At a mean follow-up of 13.1 months, 19 (45%) of the patients had improvement in Facial Nerve function and 23 (55%) had static functioning. None of them had worsened. With medical intervention and tarsorrhaphy, the corneal condition was improved in all patients. Conclusion: Isolated FNP is an unusual but important sign in the presentation of mucormycosis which can be misdiagnosed with a cerebrovascular accident leading to delay in the management. This is a large case series with isolated FNP in CAM cases. A high index of suspicion for mucormycosis in diabetic patients presenting with isolated facial palsy can save the life and salvage the eye.","PeriodicalId":91939,"journal":{"name":"Open access journal of ophthalmology","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2023-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Isolated Lower Motor Neuron Facial Nerve Palsy as a Presenting Sign in COVID-19 Associated Orbital Mucormycosis Patients: A Retrospective Observational Study\",\"authors\":\"A. R\",\"doi\":\"10.23880/oajo-16000270\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"Purpose: The main purpose of this study is to emphasize that isolated facial nerve involvement can be the first presenting symptom in patients suspected of COVID-associated Mucormycosis (CAM). Methods: This study is a retrospective observational study conducted at a tertiary care referral center which included patients with a history of CAM, who presented with isolated facial nerve palsy as initial presentation between March 2021 to March 2022 along with their follow-up. All the patients were managed with combined modality treatment with antifungal therapy and debridement of the necrotic tissue and fungal debris. Results: There were 184 eyes of 148 patients diagnosed with CAM. All patients developed rhino-orbital mucormycosis (ROM) following the COVID-19 infection and the duration between diagnosis of COVID-19 and ROM was 36±23 days. 42(28%) patients presented with isolated Facial Nerve Palsy (FNP) as the initial presentation. The mean age was 48.5 years (range 38 to 67years) with a male predominance of 29 (69%). All were unilateral cases and were of Lower motor neuron type presentation. All the patients (100%) were treated with systemic Liposomal amphotericin-B and sinus debridement. At a mean follow-up of 13.1 months, 19 (45%) of the patients had improvement in Facial Nerve function and 23 (55%) had static functioning. None of them had worsened. With medical intervention and tarsorrhaphy, the corneal condition was improved in all patients. Conclusion: Isolated FNP is an unusual but important sign in the presentation of mucormycosis which can be misdiagnosed with a cerebrovascular accident leading to delay in the management. This is a large case series with isolated FNP in CAM cases. A high index of suspicion for mucormycosis in diabetic patients presenting with isolated facial palsy can save the life and salvage the eye.\",\"PeriodicalId\":91939,\"journal\":{\"name\":\"Open access journal of ophthalmology\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2023-01-02\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Open access journal of ophthalmology\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.23880/oajo-16000270\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Open access journal of ophthalmology","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.23880/oajo-16000270","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
Isolated Lower Motor Neuron Facial Nerve Palsy as a Presenting Sign in COVID-19 Associated Orbital Mucormycosis Patients: A Retrospective Observational Study
Purpose: The main purpose of this study is to emphasize that isolated facial nerve involvement can be the first presenting symptom in patients suspected of COVID-associated Mucormycosis (CAM). Methods: This study is a retrospective observational study conducted at a tertiary care referral center which included patients with a history of CAM, who presented with isolated facial nerve palsy as initial presentation between March 2021 to March 2022 along with their follow-up. All the patients were managed with combined modality treatment with antifungal therapy and debridement of the necrotic tissue and fungal debris. Results: There were 184 eyes of 148 patients diagnosed with CAM. All patients developed rhino-orbital mucormycosis (ROM) following the COVID-19 infection and the duration between diagnosis of COVID-19 and ROM was 36±23 days. 42(28%) patients presented with isolated Facial Nerve Palsy (FNP) as the initial presentation. The mean age was 48.5 years (range 38 to 67years) with a male predominance of 29 (69%). All were unilateral cases and were of Lower motor neuron type presentation. All the patients (100%) were treated with systemic Liposomal amphotericin-B and sinus debridement. At a mean follow-up of 13.1 months, 19 (45%) of the patients had improvement in Facial Nerve function and 23 (55%) had static functioning. None of them had worsened. With medical intervention and tarsorrhaphy, the corneal condition was improved in all patients. Conclusion: Isolated FNP is an unusual but important sign in the presentation of mucormycosis which can be misdiagnosed with a cerebrovascular accident leading to delay in the management. This is a large case series with isolated FNP in CAM cases. A high index of suspicion for mucormycosis in diabetic patients presenting with isolated facial palsy can save the life and salvage the eye.