Rhino-orbital Mucormycosis as a complication of severe COVID-19 pneumonia

Abstract

Mucormycosis has multiple clinical phenotypes, which are more common in immunocompromised patients, especially those with diabetes mellitus. Debilitating rhino-orbital-cerebral and pulmonary infections by far represent the most typical clinical phenotypes associated with these fungi. Mucormycosis is an uncommon infection; however, there have been isolated sporadic tiny outbreaks around the world. With the substantial increase in COVID-19 cases in India, there is a parallel increase in the number of cases of Mucormycosis. A few reports raising unusual concomitant mucormycosis in COVID-19 patients have raised a possible association between the two diseases. We report a 59-year-old male with an established history of uncontrolled diabetes mellitus admitted to the hospital with severe COVID-19 pneumonia (severity ascertained according to WHO classification) treated with steroids and discharged home following full recovery. However, one week later, he presented with right eye ophthalmoplegia and complete loss of vision, which was subsequently established as orbital Mucormycosis. This case highlights the need for heightened awareness of this atypical secondary infection (especially systemic mycosis) in patients recovering from COVID-19 infection.

COVID-19 and Fungal infections: a double debacle

“… Clinical presentation of mucromycosis Number of cases Causative agents References Rhino-orbital 10 Rhizopus spp. Mucor ( 111 , 112 , 113 , 114 , 115 , 116 , 117 , 118 , 119 , 120 ) Rhino-cerebral 1 N/A ( 121 ) Rhino-orbital-cerebral 2 Rhizopus spp. ( 122 , 123 ) Sino-orbital 1 Rhizopus oryzae ( 124 ) Paranasal 1 N/A ( 125 ) Pulmonary 8 Zygomycetes Rhizopus arrhizus Rhizopus azygosporus Rhizopus microsporus ( 126 , 127 , 128 , 129 , 130 , 131 , 132 , 133 ) Oral 1 N/A ( 134 ) Gastrointestinal 1 N/A ( 135 ) Cutaneous 1 Mucor …”

COVID-19 Vaccine-Induced Cerebral Sinus Thrombosis: Coincidence vs. Cause?

“…However, there are also rare instances of vaccine-induced CVST. Here we present and study two cases of it [ 5 ].…”

Rhinocerebral Mucormycosis in Patients with Diabetes Mellitus After a New Coronavirus Infection (COVID-19): СT and MRI Patterns Data

“…Немаловажную роль в увеличении числа пациентов с иммунодефицитными состояниями сыграла пандемия коронавирусной инфекции (COVID- 19), тяжелое и среднетяжелое течение которой сопровождается мощной иммуносупрессией с нарушением не только местных, но и системных механизмов иммунной защиты. Согласно последним данным пандемия COVID-19 вызвала во всем мире рост коинфекции инвазивных микозов (аспергиллеза, мукормикоза) у пациентов с иммунодефицитом, в частности у больных сахарным диабетом [3,5,6,[11][12][13][14][15][16][17][18]. Среди инвазивных микозов наблюдается устойчивый всплеск коинфекций мукормикоза, что привело к появлению термина « мукормикоз, связанный с COVID-19» [5].…”