COVID-19 triggering mucormycosis in a susceptible patient: a new phenomenon in the developing world?

A middle-aged woman with diabetes presented with left-sided facial pain, complete ptosis and fever of short duration. On presentation, she had hyperglycaemia without ketosis. There was total ophthalmoplegia of the left eye with a visual acuity of 6/36. She incidentally tested positive for COVID-19....

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Bibliographic Details
Published in:	BMJ case reports Vol. 14; no. 4; p. e241663
Main Authors:	Revannavar, Shweta Mallikarjun, P S, Supriya, Samaga, Laxminarayana, V K, Vineeth
Format:	Journal Article
Language:	English
Published:	England BMJ Publishing Group LTD 27-04-2021 BMJ Publishing Group
Subjects:	Amphotericin B - therapeutic use Antibiotics Antifungal agents Antifungal Agents - therapeutic use Blepharoptosis - complications Blood Brain - diagnostic imaging Carotid arteries Case Report Case reports Coronaviruses COVID-19 COVID-19 - complications Cytokines Diabetes Diabetes Complications Disease Female Fungal infections Hemoglobin Humans Immune system Infections Inflammation Ketosis Lymphocytes Magnetic Resonance Imaging Middle Aged Mortality Mucormycosis - diagnosis Mucormycosis - drug therapy Ophthalmoplegia - complications Orbital Diseases - complications Orbital Diseases - diagnostic imaging Orbital Diseases - etiology Otolaryngology Paranasal Sinus Diseases - complications Paranasal Sinus Diseases - diagnostic imaging Patients SARS-CoV-2 Severe acute respiratory syndrome coronavirus 2 Sinuses Stroke Surgery Tomography, X-Ray Computed Treatment Outcome Viral infections India COVID-19 tropical medicine (infectious disease) diabetes stroke
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Summary:	A middle-aged woman with diabetes presented with left-sided facial pain, complete ptosis and fever of short duration. On presentation, she had hyperglycaemia without ketosis. There was total ophthalmoplegia of the left eye with a visual acuity of 6/36. She incidentally tested positive for COVID-19. CT paranasal sinus and MRI brain revealed left-sided pansinusitis with acute infarct in the left parieto-occipital region without angioinvasion. An emergency functional endoscopic sinus procedure was done, which confirmed mucormycosis on histopathological examination. After 1 week of conventional amphotericin B and antibiotics, repeat CT brain showed improvement in mucosal thickening and sinusitis. This case is a rare presentation of mucormycosis associated with rapid progression to orbital apex syndrome with brain infarction in a patient with non-ketotic diabetes and COVID-19. Early diagnosis and treatment are essential to prevent further end-organ damage. It is also interesting that there was no angioinvasion and transient periarterial inflammation was attributed to brain infarction.
Bibliography:	ObjectType-Case Study-2 SourceType-Scholarly Journals-1 ObjectType-Feature-4 content type line 23 ObjectType-Report-1 ObjectType-Article-3
ISSN:	1757-790X 1757-790X
DOI:	10.1136/bcr-2021-241663