RHINO-ORBITO-CEREBRAL MUCORMYCOSIS ASSOCIATED WITH COVID 19

Dr. Ajit Hange, Dr. Anita Basavaraj*, Dr. Vaibhav Lamdhade, Dr. Rahul Jadhav, Dr. Neha Kadam-Duke, Dr. Chaitanya Patil

ABSTRACT

COVID-19 disease presents with wide variety of extra-pulmonary manifestation and may be associated with number of bacterial and fungal co-infections. We report the case of a patient with COVID-19 disease, which, during the course of the treatment, developed rhino-orbito-cerebral mucormycosis. A 49 year old female patient, a longstanding diabetic and hypertensive, with a positive reverse transcriptase polymerase chain reaction (RT-PCR) for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was admitted for treatment. She received intravenous piperacillin-tazobactum, methyl prednisolone and remdesivir. Over the course of the admission, she developed signs of orbital cellulitis. She had right opthalmoplegia with Left sided hemiplegia. Histopathologic examination from maxillary sinus was suggestive of mucormycosis. CT brain contrast with CT angio showed complete occlusion of Right middle cerebral artery and Right cavernous sinus thrombosis. She responded to liposomal Amphotericin B. Extensive use of steroids and broad-spectrum antibiotics may lead to the development or exacerbation of a preexisting fungal disease. Physicians should be aware of the possibility of secondary invasive fungal infections in patients with COVID-19 infection.

Keywords: Mucormycosis, Diabetes, Cavernous sinus thrombosis, Amphotericin B.