Rhino-orbito-cerebral mucormycosis caused by Rhizopus microsporus var. microsporus in a diabetic patient with COVID-19

Abstract

COVID-19 disease caused by the SARS-CoV-2 coronavirus causes a wide range of clinical manifestations, ranging from mild to severe, with the main ones affecting the respiratory tract, such as pneumonia. In patients with greater severity, the high frequency of bacterial and fungal coinfection stands out, a situation related both to the patient's pre-existing comorbidities and due to the hospitalization itself. Cases of mucormycosis associated with COVID-19 were highlighted in the lay and scientific media, with the increase in mycosis cases being directly and indirectly attributed to the viral infection. This report describes a case of rhino-orbito-cerebral mucormycosis in a diabetic patient hospitalized for COVID-19, whose diagnosis was confirmed by identifying the agent Rhizopus microsporus var. microsporus through culture for fungi and PCR examination.

Keywords: Amphotericin B; COVID-19; Coronavirus; Diabetes mellitus; Diagnosis; Mucormycosis.

Figure 1

Erythema and severe swelling of the conjunctiva associated with upper eyelid erythema. Rhino-orbito-cerebral mucormycosis.

Figure 2

Histopathological section of a surgical specimen from the patient with rhino-orbito-cerebral mucormycosis showing coenocytic hyphae at ×400 magnification. (A), Hematoxylin & eosin. (B), PAS staining. (C), Grocott Gomori staining.

Figure 3

Rhizopus microsporus. (A), Colony consisting of whitish “cotton-wool” mycelium and blackish granular aerial mycelium. (B), Microculture showing coenocytic hypha with rhizoids, sporangiophore and empty sporangia. The presence of sporangiospores is observed around the structure (Cotton blue, ×400).