Rhinocerebral mucormycosis in COVID-19 patient with diabetes a deadly trio: Case series from the north-western part of India

Abstract

Coronavirus disease 2019 (COVID-19), may present with a myriad of clinical manifestations and complications. Patients with COVID-19 are at increased risk of pulmonary thromboembolism, acute cardiac injury, arrhythmias, acute stroke, and secondary infections. Mucormycosis is a catastrophic fungal infection characterized by vascular invasion, thrombosis, and necrosis of tissues. We report five cases of COVID-19 infection, who developed rhino-orbital mucormycosis, during the course of treatment. Early recognition of this life-threatening infection is the key to allow for optimal treatment and improved outcomes.

Keywords: COVID-19; Mucormycosis; Rajasthan.

Fig. 1

Fig. 1a. CT scan showing mucoperiosteal thickening in bilateral maxillary, ethmoid, left frontal sinuses, and blocked right osteomeatal opening (blue arrow). Fig. 1b. Lactophenol cotton blue mount of nasal discharge showing broad aseptate hyphae with sporangiospore (red arrow) of rhizopus. Fig. 1c. Image of Case 3 showing right periorbital swelling, black patch on right lids. Fig. 1d. T2W MRI showing hypointense lesion causing expansion of nasal cavity, erosion of ethmoid sinus and medial wall of left orbit (blue arrow) causing mass effect on left medial rectus muscle and proptosis of left eye ball. Fig. 1e. Mild proptosis (green arrow), pre-orbital soft tissue swelling and altered shape of right orbit, thickening and peri-neural fat stranding of right optic nerve, and bulky right cavernous sinus (red arrow) suggestive of right pre and post septal orbital cellulitis, endo-ophthalmitis, and right cavernous thrombosis. Fig. 1f. Image of Case 5 showing bilateral facial and eye (right > left) swelling with necrosis of surrounding skin.