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Case Reports
. 2021 Apr 27;14(4):e241663.
doi: 10.1136/bcr-2021-241663.

COVID-19 triggering mucormycosis in a susceptible patient: a new phenomenon in the developing world?

Shweta Mallikarjun Revannavar  1 , Supriya P S  2 , Laxminarayana Samaga  2 , Vineeth V K  2
Affiliations
Case Reports

COVID-19 triggering mucormycosis in a susceptible patient: a new phenomenon in the developing world?

Shweta Mallikarjun Revannavar et al. BMJ Case Rep. .

Abstract

A middle-aged woman with diabetes presented with left-sided facial pain, complete ptosis and fever of short duration. On presentation, she had hyperglycaemia without ketosis. There was total ophthalmoplegia of the left eye with a visual acuity of 6/36. She incidentally tested positive for COVID-19. CT paranasal sinus and MRI brain revealed left-sided pansinusitis with acute infarct in the left parieto-occipital region without angioinvasion. An emergency functional endoscopic sinus procedure was done, which confirmed mucormycosis on histopathological examination. After 1 week of conventional amphotericin B and antibiotics, repeat CT brain showed improvement in mucosal thickening and sinusitis. This case is a rare presentation of mucormycosis associated with rapid progression to orbital apex syndrome with brain infarction in a patient with non-ketotic diabetes and COVID-19. Early diagnosis and treatment are essential to prevent further end-organ damage. It is also interesting that there was no angioinvasion and transient periarterial inflammation was attributed to brain infarction.

Keywords: COVID-19; diabetes; stroke; tropical medicine (infectious disease).

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Patient presented with left total ophthalmoplegia.
Figure 2
Figure 2
Coronal section of CT paranasal sinus showing left ethmoid sinusitis encroaching on the lamina papyracea.
Figure 3
Figure 3
Cross-sectional image of MRI brain (DWI and ADC mismatch) showing acute infarct of the parieto-occipital lobe. ADC, apparent diffusion coefficient; DWI, diffusion weighted image.
Figure 4
Figure 4
MRI brain showing periarterial inflammation of internal carotid artery (red arrowhead).
Figure 5
Figure 5
Chest X-ray (PA view). PA, posteroanterior.
Figure 6
Figure 6
Coronal section of CT paranasal sinus showing reduced opacification of the left ethmoid sinus.
See this image and copyright information in PMC

Comment in

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