Rhinocerebral Mucormycosis and COVID-19 Pneumonia

Abstract

As the coronavirus disease 2019 (COVID-19) pandemic is evolving, more complications associated with COVID-19 are emerging. In this case report, we present a case of rhinocerebral mucormycosis concurrent with COVID-19 pneumonia in a 41-year-old man with a history of type 1 diabetes mellitus (T1DM). COVID-19 pneumonia was diagnosed with reverse transcription-polymerase chain reaction (RT-PCR). He was promptly treated with steroids and hydroxychloroquine, as this was the recommended regional COVID-19 practice patterns at the time. He was treated with intravenous (IV) fluids and an insulin drip for his diabetic ketoacidosis (DKA), cefepime and IV abelcet, along with three surgical debridements for the rhinocerebral mucormycosis. The pneumonia resolved during the course of his stay in the hospital. With prompt diagnosis and treatment of rhinocerebral mucormycosis, the patient was cleared for discharge and was instructed to complete his course of treatment with coumadin and IV abelcet at home. Saprophytic fungi cause rhinocerebral mucormycosis, a rare opportunistic infection of the sinuses, nasal passages, oral cavity and brain. It usually occurs in patients with poorly controlled diabetes mellitus or those who are immunocompromised, which is again demonstrated in this case report. In the setting of COVID-19 pneumonia and an underlying condition, healthcare professionals should act promptly. In cases where mucormycosis infection is suspected, a prompt diagnosis and treatment should be started because of the angioinvasive character and rapid disease progression that contribute to the severity of the mucormycosis infection.

Mucormycosis: An opportunistic pathogen during COVID-19

“…In Tamil Nadu, till June 9, 2021, total mucormycosis reported being to be 1196 ( Josephine, 2021 ). The mucormycosis stemming from COVID-19 patients has been more commonly observed in patients with a history of diabetes mellitus and 95% of individuals with severe or critical COVID-19 ( Alekseyev et al, 2021 ; John et al, 2021 ). In addition to this, a two month old heart transplant patient developed mucormycosis three months after the COVID-19 diagnosis.…”

“…Hosts susceptible to mucormycosis include diabetics, those on systemic corticosteroid use, patients with neutropenia and hematologic malignancies, stem cell transplant patients and immunocompromised individuals ( Binder et al, 2014 ). Reports suggest that diabetic patients are more prone to acquire COVID-19 accompanied by mucormycosis infection (Mehta and Pandey., 2020; Mekonnen et al, 2021; Ahmadikia et al, 2021 ; Alekseyev et al, 2021 ; Ravani et al, 2021; Garg et al, 2021). The potential mechanism by which diabetes increases COVID-19 morbidity, and mortality is a) reduced viral clearance, b) decrease in T-cell function, c) high cytokine storm, d) immune-suppression ( Balachandar et al, 2020b ).…”

“…RT-PCR reported to be positive for COVID-19. Sinuses and intracranial abscess in the infratemporal fossa with cavernous sinus enhancement The severity of infection is due to uncontrollable diabetes with COVID-19 Alekseyev et al (2021) 31 patients Diabetes, COVID-19 Vision diminution and ophthalmoplegia Ophthalmic examination Imaging studies amphotericin B Orbital cellulitis and pansinusitis was observed with mucormycosis. 28 patients recovered.…”

COVID-19 associated mucormycosis: the urgent need to reconsider the indiscriminate use of immunosuppressive drugs

“…A prompt diagnosis and treatment should be established because of the angioinvasive character and rapid disease progression leading to a high mortality. 48 , 49 This is especially true in India; with an increased incidence of COVID-19 cases, apparently thousands of CAM cases are reported. However, Nepal, Brazil, Colombia, the USA, and other severely affected nations should consider this fungal threat amid the pandemic.…”

Post-COVID-19 rhino-orbito-cerebral mucormycosis: a new addition to challenges in pandemic control

“…However, its addition to the spectrum of COVID-19 has posed a new challenge due to an already weakened immunity with concomitant multi-system compromise due to the virus itself. As cases continue to be reported globally, still much needs to be known about this deadly combination of virus and fungus, which is slowly becoming an epidemic in itself [21][22][23][24].…”