Acute Invasive Fungal Rhinosinusitis and Coronavirus Disease 2019

Abstract

Acute invasive fungal rhinosinusitis (mucormycosis) is a rare, highly fatal disease. This opportunistic fungal infection causes angioinvasion and ischemic tissue necrosis. It mainly affects immunocompromised patients. Since the coronavirus disease 2019 (COVID-19) outbreak, many case reports have described the rhino-orbital-cerebral mucormycosis associated with COVID-19. However, the underlying predisposing factors are unknown. Several factors, other than diabetes, which is the most well-known contributing factor, may be involved in causing this severe fungal infection in COVID-19 patients. These factors may include steroid therapy, which is being used in severely dyspneic patients, the use of broad-spectrum antibiotics that may cause fungal flare-ups, and hospitalization with possible nosocomial infections. In addition, increased serum ferritin levels, possible endothelial damage, and pancreatic islets affection among COVID-19 patients may be implicated. Head and neck surgeons should be aware of the increasing prevalence of craniofacial mucormycosis among COVID-19 patients, as early diagnosis and prompt treatment are essential to improve the outcomes.

FIGURE 1

A patient with rhino-orbital-cerebral mucormycosis: (A) the arrow points to proptosis of right eye. (B) Endoscopic view of the right side of the nose with the arrow points to gangrenous middle turbinate. (C) Computed tomography shows the lesion that fills the right nasal cavity and sinuses with destruction of the medial orbital wall and cribriform plate (arrow). (D) Magnetic resonance imaging shows the lesion in the right side of the nose and sinuses invading the orbit and reaching the frontal lobe of the brain (arrow).