Sino-orbital mucormycosis in a COVID-19 patient: A case report

Abstract

Introduction We report a case of post COVID-19 Sino-orbital Mucormycosis infection caused by Rhizopus oryzae and its management. Presentation of case The patient was diagnosed with COVID-19 and treated according to the persisting protocols. Following recovery, on the 18th day, the patient developed chemosis and pain in the left eye. A diagnosis of mucormycosis was established after Magnetic Resonance Imaging (MRI) and Functional Endoscopic Sinus Surgery (FESS). Initially, conservative management with intravenous (IV) Fluconazole & Amphotericin B was done and later on with surgical debridement. The patient recovered with minimal residual deformity. Discussion Mucormycosis generally develops secondary to immunosuppression or debilitating diseases. In Head and Neck cases, the mold usually gains entry through the respiratory tract involving the nose and sinuses, with possible further progression into the orbital and intracranial structures. Hence, an early diagnosis and intervention is required for a good prognosis, decreasing the morbidity. This can be achieved on the basis of clinical picture and direct smears. Conclusion Research needs to be carried out in COVID-19 patients for better prevention and management of opportunistic infections in order to reduce its incidence and morbidity. Prophylactic treatment protocols need to be established, along with rational use of corticosteroids.

Mucormycosis: An opportunistic pathogen during COVID-19

“…Although these factors such as diabetes, organ transplantation and hematological factors are commonly linked to mucormycosis, it is evident that COVID-19 infection also acts as a trigger in these situations. In addition, it has also been observed that people with no history of any underlying condition can also be diagnosed with mucormycosis post-COVID-19 infection ( Maini et al, 2021 ). There are many plausible explanations for the occurrence of mucormycosis post-COVID-19 infection.…”

“…Aseptate, branching broad based fungal hyphae, areas of necrosis with granulomas were seen. Rhizopus oryzae was noticed in COVID-19 patients hence better prevention and management is required Maini et al (2021) 32 year old women Diabetes with ptosis and left facial pain CT scan Nasal endoscopy MRI – Opacification of the left ethmoid, maxillary and frontal sinus indicative of fungal sinusitis. Subperiosteal lesion in the superomedial extraconal of the left orbit Orbital apex syndrome with mucormycosis in COVID-19 patients requires emergency diagnosis and treatment strategies.…”

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

“…The increasing number of recent case series of mucormycosis complicating COVID-19 patients in the United States, 10 – 16 Austria, 17 Brazil, 18 Mexico, 19 Italy, 20 France, 21 Iran, 22 – 24 and India, 25 – 34 raises concerns regarding the misuse of immunosuppressive drugs in patients with COVID-19. Mucormycosis is a neglected mycosis that should be considered in the context of patients with COVID-19, in the same way as COVID-19 associated pulmonary aspergillosis, and it is possibly underreported.…”

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].…”