Oxigenoterapia hiperbárica como tratamiento complementario en mucormicosis asociada a COVID-19: a propósito de dos casos

Víctor Valencia-Caballero; José Cachay-Diaz; José Huamán-Muñante; Lourdes Romaní-Montoro; Norka Vásquez-Zevallos; César Carozzi-Calvo; Cesar Chian-García; Hugo Hernández-Chávez; Cristhian Agustín-Paredes; Esteban Vergara-de la Rosa

doi:10.17843/rpmesp.2023.401.11980

Authors

Víctor Valencia-Caballero Servicio de Medicina Interna, Hospital Nacional Arzobispo Loayza, Lima, Perú. https://orcid.org/0000-0002-1125-292X
José Cachay-Diaz Servicio de Medicina Interna, Hospital Nacional Arzobispo Loayza, Lima, Perú. https://orcid.org/0000-0002-1221-8512
José Huamán-Muñante Servicio de Medicina Interna, Hospital Nacional Arzobispo Loayza, Lima, Perú. https://orcid.org/0000-0002-8712-0376
Lourdes Romaní-Montoro Servicio de Otorrinolaringología, Hospital Nacional Arzobispo Loayza, Lima, Perú. https://orcid.org/0000-0002-7360-4775
Norka Vásquez-Zevallos Servicio de Otorrinolaringología, Hospital Nacional Arzobispo Loayza, Lima, Perú. https://orcid.org/0000-0001-7478-984X
César Carozzi-Calvo Centro de Medicina Hiperbárica, Lima, Perú. https://orcid.org/0000-0002-9380-5275
Cesar Chian-García Servicio de Anatomía Patológica, Hospital Nacional Arzobispo Loayza, Lima, Perú. https://orcid.org/0000-0002-4550-8655
Hugo Hernández-Chávez Centro de Medicina Hiperbárica, Lima, Perú. https://orcid.org/0000-0003-1034-0714
Cristhian Agustín-Paredes Servicio de Anatomía Patológica, Hospital Nacional Arzobispo Loayza, Lima, Perú. https://orcid.org/0000-0002-1386-7485
Esteban Vergara-de la Rosa Servicio de Otorrinolaringología, Hospital Regional Docente de Trujillo, Trujillo, Perú. https://orcid.org/0000-0002-7461-5775

DOI:

https://doi.org/10.17843/rpmesp.2023.401.11980

Keywords:

Mucormycosis, Hyperbaric Oxygenation, COVID-19, Diabetes Mellitus, Amphotericin B, Natural Orifice Endoscopic Surgery

Abstract

We present the first two cases reported in Peru of the use of adjuvant hyperbaric oxygen therapy (HBOT) in patients with
COVID-19-associated mucormycosis (CAM). The first case is a 41-year-old woman, with pain in the left side of the face
and palatine region with purulent rhinorrhea for a month. Only an oroantral fistula was found during physical examination. The second case is a 35-year-old male, with decreased left visual acuity and palatal pain with a fistula, draining purulent secretion for four months. Both patients have history of diabetes, had moderate COVID-19 four months prior to admission, and received corticosteroid therapy for this diagnosis. Tomographic evaluation of both patients showed involvement of the maxillary sinus and surrounding bone tissue; both received diagnostic and therapeutic nasal endoscopy for debridement. Histological analysis showed that the samples were compatible with mucormycosis. The patients underwent debridement and were treated with amphotericin B deoxycholate; however, they presented torpid evolution. Then, HBOT was added and the patients showed an evident improvement after four weeks of treatment with subsequent controls without the presence of mucormycosis. We highlight the favorable evolution of these patients while receiving HBOT as treatment for a disease with high morbimortality, which emerged during the pandemic.

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