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- Page navigation anchor for RE: Mucormycosis relevant to Covid-19.RE: Mucormycosis relevant to Covid-19.
We would like to thank Dr Harikrishnan for his observations.
This is not the first case of mucormycosis that has been reported on an asymptomatic or non-severe case of COVID-19(1). Moreover, Dr Pillay in her response to our article also pointed out that the mucormycosis may have been coincidental or unrelated to the patients’ COVID-19, and we need to keep an open diagnostic differential in all immunocompromised patients presenting with oral ulcers that are pigmented and eroding, which is the hallmark of mucormycosis.
The lesion was initially small and painless and grew to 3 cm x 2.5 cm x 0.5 cm in over a month. As mentioned, the patient arrived at our clinic 22 days after she first noticed the lesion, almost a month after testing positive for SARS-CoV-2. She likely contracted the SARS-CoV-2 infection about a week before testing positive. Because the lesion was initially asymptomatic, there is a good chance that it was present for some time before she noticed it; therefore the SARS-CoV-2 infection and the mucormycosis lesion may have been coincidental in our patient.
CMAJ space limits did not allow us to show more than one photo.
Other case reports on palatal mucormycosis describe surgical debridement and amphotericin B administration as standard treatment (2,3,4).
We are orthodontists and dental surgeons with good knowledge of oral pathology and oral medicine. The corresponding author has a special interest in oral manifestations of sy...
Show MoreCompeting Interests: None declared.References
- 1. Shakir M, Maan MHA, Waheed S. Mucormycosis in a patient with COVID-19 with uncontrolled diabetes. BMJ Case Rep. 2021 Jul 29;14(7):e245343. doi: 10.1136/bcr-2021-245343. PMID: 34326123; PMCID: PMC8323390.
- 2. Sreenath G, Prakash AR, Kanth MR, Reddy PS, Vidhyadhari P. Rhinomaxillary mucormycosis with palatal perforation: a case report. J Clin Diagn Res. 2014 Sep;8(9):ZD01-3. doi: 10.7860/JCDR/2014/8881.4775. Epub 2014 Sep 20. PMID: 25386533; PMCID: PMC422598
- 3. Rai S, Misra D, Misra A, Jain A, Jain P, Dhawan A. Palatal Mucormycosis Masquerading as Bacterial and Fungal Osteomyelitis: A Rare Case Report. Contemp Clin Dent. 2018 Apr-Jun;9(2):309-313. doi: 10.4103/ccd.ccd_743_17. PMID: 29875579; PMCID: PMC5968701
- 4. Manjunatha BS, Das N, Sutariya RV, Ahmed T. Mucormycosis of the hard palate masquerading as carcinoma. Clin Pract. 2012 Feb 15;2(1):e28. doi: 10.4081/cp.2012.e28. PMID: 24765427; PMCID: PMC3981330.
- 5. https://dentalreach.today/dental-education/orthodontics-in-eluding-certain-systemic-diseases-and-infections/
- Page navigation anchor for RE: Mucormycosis relevant to Covid-19.RE: Mucormycosis relevant to Covid-19.
The presented case was an asymptomatic Covid-19 patient, yet the palatal lesion started eight days after tested Covid-19 positive. Such early Mucormycosis could not appear. The lesion is quiet huge measuring maximum of 3 cm in anterior palate which mandates a CT scan of the maxilla, which was not done. It is mentioned that surgical debridement is done and healed well with amphotericin and no pictures to confirm this. Unfortunately, the management doesn't follow any accepted Mucormycosis treatment protocol.
Additionally, the case report is from the department of Orthodontics (an unrelated speciality) without authorship from the surgeons and medicine faculty where the case was treated as said in the article, which is very unfair. Appropriate authors contribution and sequence is a discipline to follow in publications.
Competing Interests: None declared.References
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- Page navigation anchor for RE: Palatal Mucormycosis in patient with SARS-CoV-2 InfectionRE: Palatal Mucormycosis in patient with SARS-CoV-2 Infection
Thanks for your case presentation. Mucormycosis is known to occur in patients with poorly or uncontrolled diabetes and immunocompromised patients.
I suggest that the SARS CoV 2 in this patient is coincidental and not directly related to the etiology. The immunosuppression from either the infection or steroids is an important fact to note. We need to keep an open diagnostic differential in all immunocompromised patients presenting with oral ulcers that are pigmented and eroding which is the hallmark of Mucormycosis.Thanks for an interesting read. Dr LP, Regina SK.Competing Interests: None declared.References
- Adith Venugopal, Anand Marya. Palatal mucormycosis in a patient with SARS-CoV-2 infection. CMAJ 2021;193:E1254-E1254.