Radiaology of the Maxillofacial Osteomyelitis in a Patient with Burkitt’s Lymphoma and Rhinocerebral Mucormicosis as a Complication of Coronavirus Infection (COVID-19)

Introduction. There are increasing reports of adverse effects of the SARS-CoV-2 virus (COVID-19) on the bone system, especially in the maxillofacial region. Purpose. To demonstrate the possibilities of complex radiology diagnostics by multispiral computed tomography (MSCT) and positron emission computed tomography (PET/CT) methods, to show the peculiarities of radial semiotics of the maxillofacial osteomyelitis in a patient with rhinocerebral mucormycosis developed after coronavirus infection on the background of Burkitt’s lymphoma. Materials and methods. The article presents a clinical case of patient K., 41 y.o., with complaints of a defect in the region of the upper jaw after coronavirus infection, on the background of which rhinocerebral mucormycosis developed. From the patient’s history, it is known that the patient was diagnosed with Burkitt’s lymphoma in 2020, and the upper jaw was resected in 2021 with simultaneous plasty with local tissues. A comprehensive clinical and radiological examination was performed to assess the activity of the underlying disease and the dynamics of the patient’s condition at various stages of treatment. After repeated surgery in March 2022, the patient underwent MSCT in order to assess the condition of the facial skeleton. Results. Based on a comprehensive examination data, the final diagnosis was made, and the radiation semiotics of osteonecrosis of the maxillofacial region in a patient with Burkitt’s lymphoma combined with rhinocerebral mucormycosis that developed against the background of coronavirus infection was described. The most informative method for diagnosing osteonecrosis of the bones of the facial skeleton is MSCT of the maxillofacial region, which provides comprehensive information on the localization and prevalence of the lesion, which determines further treatment tactics for the patient, taking into account the identified changes. Conclusion. The literature increasingly concludes that there is a positive causal relationship between COVID-19 and the development of osteonecrosis of the maxillofacial region. In the presented clinical case, MSCT was used to diagnose osteonecrosis of the maxillofacial region, which developed against the background of a coronavirus infection, and PET/CT was used to assess the prevalence of osteonecrosis of the maxillofacial region and the activity of Burkitt’s lymphoma.

1. Ternovoy SK, Serova NS, Belyaev AS, Belyaeva KA. COVID-19: first results of radiology in response to a new challenge. REJR.2020;10(1):8-15 (In Russ.). https://doi.org/10.21569/2222-7415-2020-10-1-8-15.

2. Fomin VV, Ternovoy SK, Serova NS. Radiological guidelines in patients with COVID-19 (Sechenov University experience). REJR. 2020;10(2):8-13. (In Russ.). https://doi.org/10.21569/2222-7415-2020-10-2-8-13.

3. Suresh A, Joshi A, Desai AK, et al. COVID-19-associated fungal osteomyelitis of jaws and sinuses: An experience-driven management protocol. Med Mycol. 2022 Feb 2;60(2):myab082. https://doi.org/10.1093/mmy/myab082. PMID: 35076069. PMCID: PMC8822410.

4. Kvolik Pavić A, Zubčić V. Osteomyelitis of the Jaw in COVID-19 Patients: A Rare Condition With a High Risk for Severe Complications. Front Surg. 2022.Jul 1;9:867088. https://doi.org/10.3389/fsurg.2022.867088. PMID: 35846973. PMCID: PMC9283791.

5. Pshenichnikova ES, Babkova AA, Serova NS, et al. Radiology of actinomycosis in a patient with radionecrosis of the mandible (long-term follow-up). REJR.2022;12(1):135-140. (In Russ.). https:// doi.org/10.21569/2222-7415-2022-12-1-135-140.

6. Slavkova N, Nedevska M. Aseptic osteonecrosis of the maxilla after severe COVID-19 infection and its treatment. Radiol Case Rep. 2022. Jul 2;17(9):3228-3232. https://doi.org/10.1016/j.radcr.2022.06.009. PMID: 35801131. PMCID: PMC9250319.

7. Arshad W, Mahmood Kamal M, et al. Case of maxillary actinomycotic osteomyelitis, a rare post COVID complicationcase report. Ann Med Surg (Lond). 2022.Aug;80:104242. https://doi.org/10.1016/j.amsu.2022.104242. PMID: 35936558. PMCID: PMC9339092.

8. Babkova AA, Kureshova DN, Serova NS, et al. Complex radiological diagnosis of osteonecrosis in desomorphine dependence patients. REJR.2015;5(4):13-23. (In Russ.).

9. Zagorsky VA. Fundamentals of dentistry. 3rd edition, supplemented. Moscow: BINOM, 2017. 408 р. (In Russ.).

10. Arzhantsev AP. Radiology in dentistry: a guide for doctors. Moscow: GEOTAR-Media, 2021. 302 р. (In Russ.).

11. Gabdulganieva IS, Munirova NR, Zaripova AR, Anisimov VI. Rhinocerebral mucormycosis in patients with diabetes mellitus after a new coronavirus infection (COVID-19): СT and MRI patterns data. Journal of Radiology and Nuclear Medicine. 2022;103(4-6):36.51. (In Russ.). https://doi.org/10.20862/0042-4676-2022-103-4-6-36-51.

12. Klemin VA, Obornev LE, Obornev AL, et al. Radiation diagnostics in dentistry. Moscow: Man, 2020. 72 р. (In Russ.).

13. Chung M, Bernheim A, Mei X, et al. CT imaging features of 2019 novel coronavirus (2019-nCoV). Radiology. 2020;295(1):202e7. https://doi.org/10.1148/radiol.2020200230.

14. Ismailova MKh, Yunusova LR, Khaydarova GB, Abdullayeva LSh. Multimodal imaging of maxillofacial complications in post-COVID-19 patients with diabetes mellitus. The Bulletin of Contemporary Clinical Medicine. 2023;16(Suppl.2):19-23. https://doi.org/10.20969/VSKM.2023.16(suppl.2).19-23. (In Russ.).

15. Sahu ES, Sahu A, Ghodgaonkar P, et al. COVID19-associated rhino-orbital- cerebral mixed mycoses with intracranial fungal granuloma - an aggressively managed rare entity. Indian J Ophthalmol. 2021;69(9):2537-9. https://doi.org/10.4103/ijo.IJO_1598_21.

16. Sreshta K, Dave TV, Varma DR, et al. Magnetic resonance imaging in rhino-orbital-cerebral mucormycosis. Indian J Ophthalmol. 2021;69(7):1915-27. https://doi.org/10.4103/ijo.IJO_1439_21.

17. Honavar SG. Code mucor: guidelines for the diagnosis, staging and management of rhino-orbito-cerebral mucormycosis in the setting of COVID-19. Indian J Ophthalmol. 2021;69(6):1361-5. https://doi.org/10.4103/ijo.IJO_1165_21.

18. Wali U, Balkhair A, Al-Mujaini A. Cerebro-rhinoorbital mucormycosis: an update. J Infect Public Health. 2012;5(2):116-26. http://doi.org/10.1016/j.jiph.2012.01.003.

19. Therakathu J, Prabhu S, Irodi A, et al. Imaging features of rhinocerebral mucormycosis: a study of 43 patients. Egyptian J Radiol Nucl Med. 2018;49(2):447-52. https://doi.org/10.1016/j.ejrnm.2018.01.001.

20. Kaushik KS, Ananthasivan R, Acharya UV, et al. Spectrum of intracranial complications of rhino-orbitocerebral mucormycosis – resurgence in the era of COVID-19 pandemic: a pictorial essay. Emerg Radiol. 2021;28(6):1097- 106. http://doi.org/10.1007/s10140-021-01987-2.