key: cord-1018926-afody59y
authors: Raghu, Dr. Roshini; Daswaney, Dr. Akash; Gopinathan, Dr. Vivek
title: Mucormycosis as a complication of Covid-19 - a case report
date: 2021-09-02
journal: Vis J Emerg Med
DOI: 10.1016/j.visj.2021.101150
sha: 63c0fbb4280880e89db0eae72ae9adaab2b0a100
doc_id: 1018926
cord_uid: afody59y

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beats/minute and respiratory rate was 16 breaths/min. She was unable to open her right eye due to edema and there was chemosis of right eye. Absence of light reflex and extraocular movements were noted. A black eschar measuring 2 x 2 cm, was noted on the hard palate and black crusts were noted in the right inferior meatus. On systemic examination, there were bilateral crepitations. Other Systemic examination findings revealed no positive findings. She was empirically started on Amphotericin B. Given the chief complaints and the positive physical examination findings, a rapid antigen Covid-19 test was done in the ER which came to be positive and fungal staining of specimen from the palate revealed broad hyaline sparsely septate filamentous hyphae suggestive of mucormycosis.

Intraoperatively, the entire septum and right sided turbinates were necrosed and sloughed off. Laterally there was involvement of maxilla and superiorly the necrosis extended till the cribriform plate. She underwent open debridement and orbital exenteration. Postoperatively she was treated with antibiotics, insulin, and supplemental oxygen. Tracheostomy was done to prevent aspiration and secondary suturing was done on post-op day 14. Patient tolerated the surgery well and was treated in the ICU in view of increased oxygen requirements. She was stable at discharge on day 36.

Covid-19 is a global pandemic with over 3 million deaths worldwide. There are a few pathophysiological variables responsible for the Covid-19 causing disseminated fungal infections, including its extensive pulmonary disease and the immune dysregulation associated with Covid-19. (1) Steroids that are used for severe Covid-19 patients have been attributed to increasing incidence of opportunistic infections among Covid-19 patients. (2) Mucormycosis is a common complication noticed in the second wave of the Covid-19 pandemic in India with the first 6 cases reported in February 2020.(3) Early diagnosis and treatment of this condition is crucial to prevent the angioinvasion, which is a life-threatening complication of the fungus. Clinical or clinico-radiological findings along with direct microscopy of lesions are the cornerstones for early diagnosis. However treatment with Amphotericin B should be started empirically while awaiting culture reports. Life-saving surgical procedures like paranasal sinus surgery, orbital exenteration are to be opted for failing medical therapy.(3) This case highlights the importance of this major complication that has been a great obstacle during and after the treatment of Covid-19 patients. CT image of the orbit showing a small breach/ dehiscence in the lamina papyracea of right orbit (blue arrow) with resultant few extraconal air pockets in the inferior and medial aspects of the right orbit (pink arrows). There is significant intraorbital fat stranding (yellow arrow) and bulky inferior and medial recti and inferior oblique muscles (red stars). There is proptosis of the right globe (red arrows) and sinus opacification (yellow star)  Figure 3 : CT image of the orbits showing near complete soft tissue opacification is seen in right ethmoidal air cells (red arrows) and infiltration of the right orbit (yellow arrow).

Invasive fungal diseases during COVID-19: We should be prepared

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Which of the following is the life-threatening complication of untreated Mucormycosis?