Coronavirus Disease (COVID-19) Associated Rhinocerebral Mucormycosis and Complications: A Case Report

Authors

  • Soad Al Osta School of Medicine, Lebanese American University, Byblos, Lebanon
  • Gibran Atwi School of Medicine, Lebanese American University, Byblos, Lebanon
  • Nourhan El Ahmar, MD Pathology Division, Lebanese American University Medical Center-Rizk Hospital LAUMC-RH, Beirut, Lebanon
  • Noha Bejjani, MD Pathology Division, Lebanese American University Medical Center-Rizk Hospital LAUMC-RH, Beirut, Lebanon
  • Fayez Abillama, MD Critical Care Division, Lebanese American University Medical Center-Rizk Hospital LAUMC-RH, Beirut, Lebanon
  • Kamal Matli, MD Cardiology Division, Lebanese American University Medical Center-Rizk Hospital LAUMC-RH, Beirut, Lebanon

DOI:

https://doi.org/10.38179/ijcr.v2i1.102

Keywords:

Rhinocerebral mucormycosis, COVID-19, Diabetes mellitus, Glucocorticoids, Opportunistic infections

Abstract

Background: Mucormycosis is a rare fatal infection caused by a ubiquitous fungus from the order of Mucorales, which can have varying clinical presentations. Immunocompromised patients are particularly susceptible to mucormycosis and can suffer fatal consequences if not treated adequately. COVID-19 infection with its immunomodulatory properties has been associated with a wide range of secondary bacterial and fungal infections. We present a case of rapidly progressive rhinocerebral mucormycosis post-COVID-19 infection with the subsequent development of several complications associated with the disease.

Case Report: A 62-year-old male patient with a history of hypertension and diabetes mellitus type II, presented 14 days post-COVID-19 recovery with right facial swelling, erythema, and right eye proptosis. Throughout his disease, the patient developed blindness and cranial nerve palsies. He was also found to have palatal necrotic lesions, consistent with the diagnosis of mucormycosis. The patient’s disease was complicated by Garcin syndrome, meningitis, orbital apex syndrome, cavernous sinus thrombosis, brain infarction, and hemorrhage. Despite all measures and interventions, the patient died.

Conclusion: COVID-19 infection and its treatments are associated with an increased risk of secondary fungal infections like mucormycosis. As such, a high index of suspicion is needed amongst healthcare workers for the early diagnosis and treatment of such opportunistic infections since prompt treatment is associated with a marked improvement in outcome. Furthermore, optimal glucose control and judicious use of corticosteroids in COVID-19 patients decreases the risk of developping such life threatening superinfections.

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(A) H and E-stained section (4x) from palate region showing squamous epithelium with necrosis and focal ulceration and a (B) (40x) magnification revealing non septated broad fungal hyphae (arrow) within a background of epithelial cells and inflammatory cells, (C) Grocott stained section (40x) showing non septated fungal hyphae branching at 90-degree angle in black (arrow), (D) periodic acid–Schiff-stained section (40x) highlighting broad non septated fungal hyphae in pink.

Published

2021-10-09

How to Cite

Al Osta, S., Atwi, G., El Ahmar, N., Bejjani, N., Abillama, F., & Matli, K. (2021). Coronavirus Disease (COVID-19) Associated Rhinocerebral Mucormycosis and Complications: A Case Report. International Journal of Clinical Research, 2(1), 93-99. https://doi.org/10.38179/ijcr.v2i1.102