Mucormycosis, an angioinvasive fungal infection caused by fungi of the order Mucorales, presents a significant health burden especially after COVID-19 epidemic. The most common clinical manifestation is rhino-orbital-cerebral mucormycosis (ROCM), primarily affecting immunocompromised patients [1]. Diagnosis involves recognizing risk factors, evaluating clinical manifestations, employing imaging modalities, and performing histopathology and cultures. Hot et al. (2010), in their prospective study has demonstrated the potential of [18 F]FDG-PET in the initial and residual staging of invasive fungal infections (IFIs), showing superior detection rates compared to conventional CT. Similarly. Douglas et al. (2018) reported FDG PET-CT localizes clinically occult infections and track response to antifungal therapy more effectively than CT. PET-CT’s ability to detect active metabolic changes, reflecting inflammatory cell activity, emphasizing its potential in detecting residual disease. The present prospective study aims to evaluate PET-CT’s efficacy in assessing residual disease in postoperative mucormycosis patients, which was conducted on 51 postoperative mucormycosis patients at a tertiary healthcare center in Delhi over 12 months (2022–2023). Inclusion criteria were post-surgical debridement cases of mucormycosis, with exclusions for intracranial disease, deranged kidney function, and uncontrolled DM. PET-CT scans were performed six weeks post-surgery. Data were then compared with operative procedures performed. The study population’s age ranged from 24 to 80 years, Surgical procedures included subtotal maxillectomy, inferior maxillectomy, medial maxillectomy, and total maxillectomy. PET-CT detected residual disease in 49% of patients. The distribution of residual disease was: maxillary sinus (31%), ethmoid sinus (13%), frontal sinus (10%), sphenoid sinus (21%), orbit (13.7%), and other sites like pterygoids and infra-temporal fossa (10%). Residual disease was present in 50% of subtotal maxillectomy cases, 55% of inferior maxillectomy cases, 50% of total maxillectomy cases, and 16% of medial maxillectomy cases. Re-debridement surgery was done in 40% of patients with residual disease depending on clinical status, whereas 60% of the patients improved on antifungals and diabetic control. Our study found PET-CT’s utility in postoperative patients, detecting residual disease in 49% of cases and correlating with clinical symptoms. Residual disease was more common following inferior or subtotal maxillectomy than total or medial maxillectomy. These findings affirm PET-CT as a valuable tool for initial staging and monitoring of mucormycosis, providing greater sensitivity than conventional CT and aiding accurate treatment evaluation. During and after COVID-19 epidemic the incidence of IFI has increased manifolds.
