Case series of central retinal artery occlusion in COVID-19-associated rhino-orbital-cerebral mucormycosis

Rhino orbital Mucormycosis caused by filamentous fungus of mucoraceae family was considered a rare disease affecting immunocompromised and diabetics with ketoacidosis until the recent COVID 19 pandemic. We are presenting a series of six cases of Rhino orbital cerebral Mucormycosis with central retinal artery occlusion. All six cases had common history of COVID 19 infection in recent past with sinusitis, proptosis and total ophthalmoplegia with central retinal artery occlusion on presentation. MR imaging showed invasive pan sinusitis with orbital and cerebral involvement. Urgent debridement was done and histopathological examination showed broad, filamentous aseptate fungi suggestive of Mucormycosis. All patients inspite of intravenous Amphotericin B with local debridement did not show any improvement and expired within a week of presentation. Hence our study shows poor prognosis of post covid 19 associated Mucormycosis with central retinal artery occlusion.

A hospital-based study on COVID-19 patients with rhino-orbital mucormycosis

Coronavirus diseases 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 virus produce opportunistic fungal infections. Mucormycosis is an acute onset rapidly progressive fatal infection. Incidence of rhino-orbital mucormycosis raised during the second wave of COVID-19 pandemic in India. Diabetes, steroid therapy, cancer, prolonged hospitalization, and metabolic acidosis are the risk factors of post-COVID-19 mucormycosis. Objectives of this study were to suggest the risk factors, clinical features, investigations, and treatment of post-COVID-19 rhino-orbital mucormycosis. This study will guide the future research and the clinician will be aware about this complication of COVID-19. After getting permission from the Institutional Ethical Committee and consent from patients, we studied 10 cases of post-COVID-19 rhino-orbital mucormycosis from April to September 2021 during our duty in COVID-19 admission desk and COVID-19 ward in NRS Medical College, Kolkata. After taking history, we observed the clinical features, investigations, and treatment of the patients. Symptoms of the patients were nasal discharge, nasal block, headache, facial swelling, and blackish discoloration of skin. Most of the patients were diabetic. Magnetic resonance imaging (MRI)-PNS was showed sinonasal mass. Amphotericin-B was used and debridement was the main surgical procedure. Microscopy showed broad aseptate hyphae suggesting mucor. Early diagnosis and proper treatment will reduce the morbidity and mortality of the patient with post-COVID rhino-orbital mucormycosis.

Risk Factors for Severe Rhino-Orbital Mucormycosis During its Epidemic Post-COVID-19 Pandemic

Postsecond wave of COVID?19 pandemic in the year 2021, rhino?orbital mucormycosis(ROM) was seen as an epidemic in the Indian community. Severe ROM disease has poor prognosis and requires a multidisciplinary approach for treatment. Hence, its prevention is better than cure. Studies done during the epidemic assessed predisposing factors, but this was a novel study which focused on assessing risk factors for severe disease of ROM. Ninety-four consecutive patients of ROM admitted at our designated nodal tertiary hospital of North India were enrolled, and data were collected and analyzed. Facial edema was the most common presenting complaint. Subclinical and mild COVID-19 infection was associated with severe ROM. Uncontrolled diabetes mellitus and prophylactic zinc supplementation were other significant risk factors for severe ROM. Public awareness among the general population for the above risk factors can prevent a debilitating disease like severe ROM.

Retrobulbar injection of amphotericin B using intravenous cannula for post-COVID-19 rhino-orbital mucormycosis

Rhino-orbital mucormycosis has seen a huge resurgence in patients post COVID-19 infection. In patients with minimal orbital disease and especially with preserved vision, retrobulbar injections of amphotericin B can be of great help in controlling the disease. Instead of giving daily injections of amphotericin B using needles every time, we used an 18-gauge intravenous (IV) cannula with injection port and suture holes to deliver the amphotericin into the orbital space for a period of 5 days. Patients were more compliant and less distressed with this method compared with being given an injection with a needle daily. We got a good response in terms of orbital disease regression with this method. In our review of the literature, we did not come across any such case of amphotericin B injection using an IV cannula. Injection of amphotericin B into the orbit using an IV cannula is a viable and easy treatment option for cases of rhino-orbital mucormycosis

A report of successfully treated rhino-orbital mucormycosis.

Rhino-cerebral mucormycosis is a rare life-threatening infection caused by fungi from the order Mucorales. The disease occurs mostly in association with diabetic ketoacidosis. Because of its rapid progression and high mortality, early recognition and aggressive treatment offer the only chance to increase the survival rate. We report a case of invasive mucormycosis in a 55 year old diabetic male, who presented with diabetic ketoacidosis and sinusitis. The patient came with complaints of swelling in right side of face, pain in right eye, right orbital swelling and numbness right cheek. An ENT examination revealed right facial swelling and proptosis. Nasal swabs were sent to microbiology for fungal culture. Material from the swab was inoculated on Sabaraud’s dextrose agar and incubated at 37°C and 25°C. The culture was identified as mucor species. Material sent for histopathology showed presence of chronic inflammatory polyp with broad aseptate hyphae suggestive of mucormycosis. On the third day, bilateral middle meatal antrostomy, bilateral anterior and posterior ethmoidectomy and bilateral wide sphenoidotomy was done. Fungal debris were noticed in both maxillary antrum. In the post-operative period, patient was started on inj. amphotericin B. On the 11th post-operative day, patient developed palatal mucosal necrosis. Under general anaesthesia, extensive surgical 2nd look and debridement was done. The necrotic palatal mucosa was completely removed. In addition to IV amphotericin B, topical douching of both nasal cavities and antrum with amphotericin B was done for 20 days. Patient improved, became completely asymptomatic and was discharged.

Liver cirrhosis and rhino-orbital mucormycosis, a possible but rare association: description of a clinical case and literature review

Only few cases of rhino-orbital mucormycosis in patients with liver cirrhosis are described in the literature and most of these patients showed an associated diabetes mellitus. We describe a case of rhino-orbital mucormycosis in a patient with liver cirrhosis without other risk factors.

A Case of Rhino-orbital Mucormycoses with Orbital Apex Syndrome in Diabetic Patient / 대한내분비학회지

Rhino-orbital mucormycosis is a rare fungal infection that involves paranasal sinus and orbits and usually presented as acute invasive fungal sinusitis or orbital apex syndrome. It often occurs in patients with poorly controlled diabetes mellitus especially during or following episode of diabetic ketoacidosis. If the condition is not treated, the fungal infection may disseminated into the brain and death usually occurs in a day to week. Exenteration is often needed as a therapy. We have experienced a case of rhino-orbital mucormycosis that presented as a orbital apex syndrome and confirmed by maxillary and periorbital soft tissue biopsy. A 56-year-old female suffered from diabetes mellitus for 3 years was admitted with rapidly progressive visual acuity loss and left hemi-facial numbness. She was treated with daily intravenous amphotericin B and intraconal amphotericin B irrigation and packing. Exenteration was not neccisated.