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.

Keywords: Amphotericin B; Case report; Covid-19; Fungal infection; Mucormycosis; Opportunistic infection.

Fig. 1

Preoperative photograph showing left eye exopthalmous and chemosis.

Fig. 2

(A) Coronal Section of MRI T1 weighted image and (B) Axial Section of MRI T2 weighted image showing extension of the lesion.

Fig. 3

(A) Inferior fornix incision marked and retraction sutures taken. (B) Inferior fornix incision taken, lateral canthotomy and inferior cantholysis done. (C) Dissection done in preseptal plane (D) Septum incised and orbit approached along the medial wall. Inferior and medial rectus muscles tagged. (E) Intraconal space entered between the two muscles. (F) Debridement of Intraconal space.

Fig. 4

Necrotic tissue removed during debridement.

Fig. 5

Lactofuchsin stained section showing typical aseptate, branching broad based fungal hyphae, areas of necrosis, epitheloid cell granulomas, multinucleated giant cells and chronic inflammatory cell infiltrate. (A) 100× (B) 10×.