Acute Invasive Rhino-Orbital Mucormycosis in a Patient With COVID-19-Associated Acute Respiratory Distress Syndrome

Abstract

Acute invasive fungal rhinosinusitis is a rare, although highly morbid, infection primarily affecting immunosuppressed individuals. The same population is at particularly high risk of complications and mortality in the setting of SARS-CoV-2 infection and coronavirus disease 2019 (COVID-19)-related acute respiratory distress syndrome. The authors present a case of acute invasive fungal rhino-orbital mucormycosis in a patient with COVID-19 and discuss the prevalence, diagnosis, and treatment of fungal coinfections in COVID-19. Prompt recognition, initiation of therapy, and consideration of the challenges of rapidly evolving COVID-19 therapy guidelines are important for improving patient survival.

FIG. 1.

Postcontrast CT of the head. A, Coronal sections with a soft tissue window demonstrating maxillary and ethmoid sinusitis, asymmetric contrast enhancement and stranding of the intraconal and extraconal orbital fat on the right compared to the left side, and subtle enlargement and enhancement of the right inferior and medial rectus muscles. B, Axial sections with a bone window demonstrating bony dehiscence of the lamina papyracea along the right medial orbital wall.

FIG. 2.

Sinus histopathology. A, Bone and sinus tissue (400×, H&E): Fungal forms infiltrating arteries (arrow). B, Sinus tissue (400×, H&E): Area of acute inflammation and fungus infiltrating arterial wall (arrow).