Bone necrosis detected among former Covid patients: HCMC hospital

Tran Anh Bich, deputy head of Cho Ray Hospital’s otorhinolaryngology department, said all 11 patients had symptoms like pain in their heads, faces and mouths during the time they had Covid-19. These symptoms didn’t subside even after they recovered from Covid-19, and they were subsequently diagnosed with other conditions like sinusitis or abscesses. However, despite various treatments, their health didn’t improve.

The first two admitted patients had surgeries to their nasal cavities and eventually got better, but a scan revealed abnormal avascular necrosis sites. Doctors recommended more surgeries, but the patients refused because they felt their health had returned to normal. Later, they succumbed to multiple organ failure and died despite treatments.

When the other patients began to show similar symptoms, doctors discovered a pattern.

“Their condition was abnormal and has never been seen before. There is currently no treatment regimen for them,” a doctor said.

The head of Cho Ray Hospital, the largest public facility in southern Vietnam, then consulted various departments to decide on a solution, and finally chose to conduct surgeries before their conditions grew worse. But six patients refused to comply, leaving only three willing to proceed, despite doctors warning they are “not sure about the rate of success.”

Nguyen Ngoc Khang, deputy head of the neurosurgery department, said that in his 30-year-long career he has never seen anything similar.

Normally, bone inflammations in the skull are rare because the area often receives sufficient blood supply and is unlikely to become necrotic. But for these patients, what appears to be common conditions like sinusitis or jaw diseases actually have necrosis involved.

Doctors from multiple departments have cooperated to perform surgeries due to the necrosis having spread too widely.

“To perform surgeries on cases we have never seen before, especially difficult ones, makes us feel worried and confused. But we would try our best until the very end to save their lives,” said Khang.

Fortunately, the surgeries were successful, and following treatments using antibiotics and antifungals, all three patients are recovering and would soon be discharged.

A 43-year-old patient in HCMC’s District 8, who’s unnamed, said she had Covid-19 in November last year. She experienced symptoms for around three days, including toothache and a swollen face. She went to a hospital for her tooth problems to be fixed, but her face remained swollen. After several more rounds of diagnoses, a CT scan revealed she had avascular necrosis and she was transferred to Cho Ray Hospital for a surgery.

“At first I thought it was a simple disease, until a doctor at Cho Ray told me that what I had was rare and abnormal. Before the surgery, doctors told me to inform my family because the condition is so new, doctors would try their best buy they don’t know whether I would live or die. Fortunately, I’m still here,” she said.

Tran Minh Truong, former deputy director of Cho Ray, said what the patients went through have already been recorded in medical documents around the world. The condition is very rare, but has become more prevalent from May last year, with 80 reports, mostly in India, China and certain countries in Asia, Europe and America. Most of them had underlying conditions like diabetes, and all had Covid-19 when the Delta variant was still rampant. Treatments often included surgeries to remove the necrotized tissues, then getting rid of infections using antibiotics and antifungals.

Le Quoc Hung, head of the tropical disease department, said the link between the condition and Covid-19 has yet to be confirmed. Necrosis often happens due to a lack of blood supply, causing living tissues to die without nutrients. It can also happen due to infections that trigger inflammation. Among the three patients who received surgeries, two had fungal infections in their skull tissues, similar to international reports.

Avascular necrosis can happen to those with diabetes, but they are usually rare. But ever since Covid-19 showed up, more cases have been recorded around the world.

“It could be because Covid-19 patients suffer from immunological disorders, and when combined with their underlying conditions, it allows fungus infections to thrive in their body,” said Hung. He said out of the 11 patients admitted to the hospital, five had diabetes.

“We don’t know yet if this condition is common, but it is likely that patients are admitted to medical facilities and died after being diagnosed as having brain abscesses or meningitis,” he said, adding that these causes of death might not be the true underlying reason.