Rhino-Orbital Mucormycosis associated with COVID-19

Abstract

Coronavirus has been associated with different bacterial and fungal infections. Of late the cases of mucormycosis or black fungus are being reported in patients with a recent history of COVID-19, especially from India. Out of 28,252 Mucormycosis cases reported 86% of infections had a history of Covid-19 and 62.3% a history of diabetes. A 75year old male diabetic patient was admitted to a tertiary care centre in a nearby hospital with a history of high-grade fever for 5 days, shortness of breath, and bodyache. Around the 20^th day, the patient developed facial swelling & pain on the left side of the face, numbness, and nasal congestion. On clinical examination, a palatal ulcer was observed on the left side of the hard palate, teeth mobility was seen. Nasal Endoscopy by ENT surgeon revealed black necrotic eschar involving Left middle turbinate & osteomeatal area. The patient’s glycated hemoglobin level was 7.5gm%  Hb. The elevated level of CRP(70 mg/l) was seen. Smear for fungus (By KOH wet mount/ with lactophenol blue) showed thick non septate & branching hyphae highly suggestive of mucormycosis. It is a dire necessity to establish protocols for diagnosis and treatment of this fatal fungal disease. Immunosuppressant need to be used with caution to decrease the aggravation of such opportunistic infection.