Clinical course and treatment challenges in post-COVID-19 rhino-orbital-cerebral mucormycosis in an immunocompetent host: A case report

Abstract

The aggressive and invasive nature of rhino-orbital-cerebral mucormycosis (ROCM) in immunocompromised patients is well documented. However, this case report aims to narrate its progression in an immunocompetent patient post-recovery from COVID-19. This case report provides a glimpse into the patient’s journey through multiple complications and painful surgeries inflicted by the disease. It emphasizes the necessity of a multidisciplinary approach to overcome the challenges posed by ROCM. In our patient, ROCM initially manifested with orbital cellulitis and paranasal sinusitis, requiring exenteration and functional endoscopic sinus surgery. Within a brief period, it advanced to the brain, resulting in a fungal abscess requiring craniotomy, abscess excision, and excision of an infiltrated maxilla through hemimaxillectomy. In addition, the exenteration and maxillectomy cavities were infiltrated by maggots, requiring further debridement. At the time of writing, the patient was undergoing a series of reconstructive surgeries to improve his social acceptability. While medical management with surgical debridement remains the gold standard in the literature, the extent of surgical debridement is still debated. Our case report not only highlights the continuous need for radical surgical interventions, which often extend to the next invaded organ but also reflects the prolonged hospital stay resulting from serial reconstructive surgeries, which take a toll on the patient. In conclusion, good teamwork with clinical foresight is required to achieve favorable treatment outcomes.