Purpose The aim of the study was to report clinical features, contributing factors and outcome of patients with coronavirus disease 2019 (COVID‐19) associated mucormycosis (CAM). Methods A cross‐sectional descriptive multicenter study was conducted on patients with biopsy‐proven mucormycosis with RT‐PCR confirmed COVID‐19 from April to September 2020. Demographics, the time interval between COVID‐19 and mucormycosis, underlying systemic diseases, clinical features, course of disease and outcomes were collected and analyzed. Results Fifteen patients with COVID‐19 and rhino‐orbital mucormycosis were observed. The median age of patients was 52 years (range 14‐71) and 66% were male. The median interval time between COVID‐19 disease and diagnosis of mucormycosis was seven (range: 1‐37) days. Among all, 13 patients (86%) had diabetes mellitus, while 7n (46.6%) previously received intravenous corticosteroid therapy. Five patients (33%) underwent orbital exenteration, while seven (47%) patients died from mucormycosis. Six patients (40%) received combined anti‐fungal therapy and none that received combined anti‐fungal therapy died. Conclusion Clinicians should be aware that mucormycosis may be complication of COVID‐19 in high‐risk patients. Poor control of diabetes mellitus is an important predisposing factor for CAM. Systematic surveillance for control of diabetes mellitus, and educating physician about the early diagnosis of CAM are suggested.

The results of this study can be used to provide a better anatomical understanding of the area, which is necessary for endoscopic skull base surgeons.

Summary Background Patients with diabetes are known as an important high‐risk group for cerebral mucormycosis (CM). Method We conducted a structured search using PubMed/MEDLINE to collect both case reports and case series case (ie including at least two patients) onto CM in diabetic patient published between 2000 and March 2020. Results Forty‐five reports of individual cases and eighteen case series articles were included. India accounted for the largest share of reports with 37.7% and 38.8% of individual cases and case series, respectively. Mortality ranged from 0% to 100% in the case series. The overall mortality in the individual cases was 46.3%, and 64.2% of deaths were reported in patients with ketoacidosis diabetes. Facial swelling (53.3%), headache (44.4%), loss of vision (35.5%) and ophthalmoplegia (35.5%) were the most frequently reported clinical symptoms. In all patients except 4 (91.1%), CM was treated surgically; however, in many cases (42%), despite the use of surgery, death occurred. Amphotericin B deoxycholate (AMB) and lipid‐based AMB (LAMB) were used as the first lines of treatment for all patients; however, posaconazole, echinocandins, hyperbaric oxygen therapy (HBOT) and deferasirox were used in combination for a number of patients. Posaconazole has been shown to have positive therapeutic effect; however, posaconazole, LAMB and HBOT are not commonly used in low‐income and health‐challenged countries. Conclusion Cerebral mucormycosis is a rapidly progressive infection in diabetic patients and carries immense morbidity despite early diagnosis and treatment. Low‐income countries have had the highest number of reports of the disease in recent years, indicating the need to control diabetes in these countries.