Fungal osteomyelitis of the skull in patients after COVID-19 associated pneumonia

Purpose. To demonstrate possibilities of multispiral computed tomography in the detection of fungal osteomyelitis in two patients with second type of diabetes mellitus two and six months after COVID-19 associated pneumonia.

Material and methods. We present two clinical observations of patients with second type of diabetes mellitus who complained about pain in the upper jaw, nasal purulent discharge, difficulty in nasal breathing which appeared two and six months after COVID-19 associated pneumonia. To identify pathological changes, patients were directed to the department of radiology for the purpose of performing MSCT of the skull.

Results. In the presented clinical cases, using MSCT, the features of the radiological semiotics of skull bone changes were studied in patients with fungal infection on the background of type 2 diabetes mellitus, the use of corticosteroids and after the viral COVID-19 associated pneumonia. The diagnosis was verified by histological and cytological studies of biopsy (surgical) material.

Discussion. Recently, there has been an increase in the number of cases of fungal osteomyelitis of the jaws and paranasal sinuses in patients after viral pneumonia caused by SARS-CoV-2. The most common fungal infection is mucormycosis, caused by fungi belonging to the order Mucorales. The rhinocerebral form of mucormycosis is common in patients with diabetes mellitus after treatment with corticosteroids with the background of immunosuppression. This form of mucormycosis contributes to the appearance of extensive bone-destructive changes in the middle and upper zones of the maxillofacial region, requiring further surgical treatment.

Conclusion. The 2019 coronavirus infection (COVID-19) caused by SARS-CoV-2 and type 2 diabetes remain urgent healthcare problems worldwide. This combination in a patient after treatment of COVID-19 associated pneumonia with corticosteroids leads to immunosuppression and the development of concomitant infections, including fungal ones. Fungal osteomyelitis in such patients, as a rule, affects the skull and is characterized by an aggressive course and requires surgical treatment. The use of modern and high-tech methods of radiation imaging, such as MSCT, allows to obtain complete diagnostic information about the localization and prevalence of the lesion, which, in the future, determines the management tactics and surgical treatment of patients of this category.

Key worlds: multispiral computed tomography, MSCT, skull, COVID-19, jaw, pneumonia, viral pneumonia, type 2 diabetes mellitus, coronavirus infection, fungal osteomyelitis, corticosteroids, maxillofacial region

Source of funding and conflict of interest. The work is presented as part of the implementation of the Grant of the President of the Russian Federation to support the Leading Scientific School NSH-599.2022.3 «Noninvasive functional technologies of radiation medicine in screening, early diagnosis, monitoring of treatment and control of rehabilitation of socially significant diseases» (head N.S. Serova).