Rhino-Orbital Mucormycosis in a COVID-19 Patient Co-Infected With Klebsiella Pneumoniae

Abstract

We present a case of a 34-year-old male with coronavirus disease 2019 and uncontrolled blood sugar with right orbital cellulitis and right ethmoidal and maxillary sinusitis. Histopathology of a middle meatus tissue biopsy collected via diagnostic nasal endoscopy (DNE) revealed the presence of Mucor and Klebsiella pneumoniae (K. pneumoniae). After the administration of intravenous (IV) insulin, cefoperazonesulbactam, and posaconazole (due to the non-availability of amphotericin B), he underwent surgical debridement and functional endoscopic sinus surgery (FESS). After being on antibiotics and antifungals for two weeks post-surgery, the patient had a favorable outcome and further tests revealed improved blood counts and inflammatory markers.

COVID-19: Update on Its Ocular Involvements, and Complications From Its Treatments and Vaccinations

“…More severe orbital complications could occur in COVID-19 patients with coexisting systemic comorbidities and the use of immunosuppressive agents such as steroids. Various cases of development of rhino-orbital mucormycosis were reported in COVID-19 patients with pre-existing diabetes mellitus (DM) and subjected to parenteral broad-spectrum antibiotics and steroids 39–46 . In these patients, ophthalmic examination revealed extensive edema of the periorbital region with soft tissue necrosis along the eyelids, proptosis, conjunctival edema, exposure keratopathy, decreased visual acuity, and restricted extraocular movement 47 .…”

“…Various cases of development of rhino-orbital mucormycosis were reported in COVID-19 patients with preexisting diabetes mellitus (DM) and subjected to parenteral broadspectrum antibiotics and steroids. [39][40][41][42][43][44][45][46] In these patients, ophthalmic examination revealed extensive edema of the periorbital region with soft tissue necrosis along the eyelids, proptosis, conjunctival edema, exposure keratopathy, decreased visual acuity, and restricted extraocular movement. 47 Fatal cases resulting from rhino-orbital cerebral mucormycosis in COVID-19 have also been documented.…”