Maxillary Mucormycosis Osteomyelitis in Post COVID-19 Patients: A Series of Fourteen Cases

Abstract

During the current pandemic of COVID-19, numerous manifestations and complications have developed. Patients with COVID-19 are at high risk of fungal infections, such as mucormycosis, that may result directly from COVID-19 infection and/or as a side effect of the drugs used in COVID-19 treatment protocol, such as dexamethasone, hydroxychloroquine, and antibiotics. In this report, we described a series of 14 cases with maxillary mucormycosis osteomyelitis in immediate post-COVID-19 patients.

Keywords: COVID-19; maxilla; mucormycosis; osteomyelitis.

Figure 1

Case#2: (A) Extraoral swelling of the right side of the face (note: sinus tract inferolaterally to the eye {arrow}). (B) Exposed necrotic bone in the right posterior palate. (C,D) 3D and cronal CT showing bone destruction of right maxilla, inferior orbital rim, and lower part of zygoma.

Figure 2

Case#3: (A) Exposed necrotic palatal bone with palatal perforations. (B,C) 3D and coronal CT showing bone destruction of right and left maxillae (not involving inferior orbital rims).

Figure 3

Case#5: (A) Exposed necrotic palatal and alveolar bone on right side. (B–D) Axial, coronal and sagittal CT showing bone destruction involving right maxilla and orbit.

Figure 4

Case#7: (A) Exposed necrotic palatal and alveolar bone on left side. (B) 3D CT showing bone destruction involving left maxilla and lower part of zygoma.

Figure 5

Case#13: (A–C) Axial and coronal CT showing bone destruction involving premaxilla, right maxilla with pterygoid plates (arrow), and not involving inferior orbital rim.

Figure 6

Nonseptate hyphae with right angle branching (arrows) and spores of mucormycosis surrounded by necrotic tissues and a dense inflammatory infiltration. ((A): H&E ×40, (B): PAS ×40).