Post COVID-19 Rhino Orbito Cerebral Mucormycosis: Who is the Real Culprit

ABSTRACT

Aim and background: Coronavirus disease 2019 (COVID-19) pneumonia has been frequently associated with symptoms such as shortness of breath, cough, loss of sense of smell, fever, and fatigue. Patients with preexisting conditions such as hypertension, diabetes mellitus, or coronary artery disease are especially susceptible to compilations arising from COVID-19 pneumonia. Patients with poorly controlled diabetes mellitus or those that are immunocompromised are at an increased risk of developing mucormycosis. Objective: To study the possible association between invasive fungal sinusitis (mucormycosis) and COVID-19. Materials and methods: A retrospective observational study was conducted at a tertiary care centre over 4 months, involving all patients with rhino orbito cerebral mucormycosis suffering from or having a history of coronavirus disease infection. Results: Seventy patients presented with mucormycosis, 65 had an association with COVID-19. The maxillary sinus and the anterior ethmoidal sinuses were the most common sinuses affected. Intra-orbital extension was seen in 30% of cases, while intracranial extension was only seen in 6%. Diabetes mellitus was present in 65 cases and was uncontrolled in 45 cases. All patients had a history of steroid use during their coronavirus treatment and 10% had tocilizumab administration. All 70 patients underwent surgical debridement, of which 21 had undergone orbital exenteration. Overall mortality was 7.6%, but with significant morbidity in survivors. Conclusion: Multiple manifestations and complications of COVID-19 are emerging as the pandemic is progressing. Mucormycosis emerged as a major health care problem with lots of morbidity and mortality, especially in the Indian subcontinent. Overzealous use of immunosuppressants along with uncontrolled diabetes was the major causative factor. Early diagnosis and early surgical debridement was the key to survival.