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.
Highlights
The coronavirus disease 2019 (COVID-19) infection caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) continues to be a global challenge
Opportunistic infections have been described in COVID-19 patients and may be associated with pre-existing comorbidities, such as diabetes mellitus and lung diseases [1]
Critically ill patients admitted to the intensive care unit (ICU), patients requiring mechanical ventilation, and patients started on systemic glucocorticoid therapy were more likely to develop fungal co-infections [2]
Summary
COVID-19 infection is associated with marked immune dysregulation, which predisposes to secondary fungal and bacterial infections. The overwhelming nature of the disease must not preclude the physician from considering other lifethreatening illnesses such as invasive mucormycosis. A high index of suspicion is needed to detect the disease early on. Treatment should be initiated immediately with antifungals and possible surgical intervention. The strongest independent risk factor for the development of mucormycosis infection, has to be adequately controlled. The overuse of medications implicated in the treatment of COVID-19, such as antibiotics and steroids, should be avoided since they are associated with adverse immunomodulatory properties
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