Abstract
BackgroundThere has been a rapid rise in the number of COVID-19-associated rhino-orbital mucormycosis (CAROM) cases especially in South Asian countries, to an extent that it has been considered an epidemic among the COVID-19 patients in India. As of May 13, 2021, 101 CAROM cases have been reported, of which 82 cases were from India and 19 from the rest of the world. On the other hand, pulmonary mucormycosis associated with COVID-19 has a much lesser reported incidence of only 7% of the total COVID-19-associated mucormycosis cases (Singh AK, Singh R, Joshi SR, Misra A, Diab Metab Syndr: Clin Res Rev, 2021). This case report attempts to familiarize the health care professionals and radiologists with the imaging findings that should alarm for follow-up and treatment in the lines of CAROM.Case presentationRhino-orbital mucormycosis (ROM) is a manifestation of mucormycosis that is thought to be acquired by inhalation of fungal spores into the paranasal sinuses. Here, we describe a 55-year-old male, post COVID-19 status with long standing diabetes who received steroids and ventilator therapy for the management of the viral infection. Post discharge from the COVID-19 isolation ICU, the patient complained of grayish discharge from the right nostril and was readmitted to the hospital for the nasal discharge. After thorough radiological and pathological investigation, the patient was diagnosed with CAROM and managed.ConclusionUncontrolled diabetes and imprudent use of steroids are both contributing factors in the increased number of CAROM cases. Our report emphasizes on the radiological aspect of CAROM and reinforces the importance of follow-up imaging in post COVID-19 infection cases with a strong suspicion of opportunistic infections.
Highlights
There has been a rapid rise in the number of COVID-19-associated rhino-orbital mucormycosis (CAROM) cases especially in South Asian countries, to an extent that it has been considered an epidemic among the COVID-19 patients in India
The day, he complained of grayish discharge from the right nostril for which he was readmitted in the hospital
A diagnosis of CAROM was established after magnetic resonance imaging (MRI), computed tomography (CT) scan, and microbiological confirmation in a background of COVID-19 infection
Summary
The importance of keeping an eye out for the subtle but critical early imaging findings as described in a known COVID-19 case with symptoms of sinusitis is imperative. Culture and microbiological confirmation takes time usually a few days by using the 7 variable CT model [13] as used in our case can be of help while awaiting the laboratory diagnosis. The typical signs such as the “Black turbinate sign” [17] may not always be seen in the early stages of the disease and suspected individuals should not be dismissed based on the absence of radiologically visible ischemic sinonasal mucosa
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