Abstract
BackgroundCorticosteroids are usually prescribed for severe cases with SARS-CoV-2 (COVID-19). Despite their importance to decrease patients’ mortality, they can cause serious side effects like fulminant fungal infection that can damage lungs or invade the sinuses then rapidly spread to the orbit and even intra-cranially. Unless early diagnosed and properly managed, patients can lose their vision or die from cavernous sinus thrombosis or other intracranial complications.Case presentationA 71-year-old diabetic male patient presented with dry cough, fever, and dyspnea for 6 days. PCR test for COVID-19 was ordered and declared positive. The oxygen saturation on day 7 started to decline to reach 90%. Eight ampules of intra-muscular dexamethasone were prescribed. The patient’s dyspnea improved, and the oxygen saturation reached 94% by day 13. Oral prednisone was prescribed in a withdrawal protocol. Unfortunately, on day 15, the patient complained of mild left-sided cheek swelling and noticeably dropped left angle of mouth. Neurological consultation suspected facial palsy and asked for brain MRI examination. Limited lower cuts of the MRI study that covered the left maxillary antrum revealed mild fullness of the pre-maxillary fat planes with mucosal thickening. Complimentary dedicated MRI and CT cuts over the left maxillary sinus showed localized signs of invasive fungal sinusitis without orbital or intracranial complications. The patient received antifungal therapy even before evident endoscopic findings appeared. He underwent endoscopic debridement few days after and he had an excellent outcome without any progression or significant morbidities.ConclusionEarly CT/MRI radiological signs of invasive fungal sinusitis that complicated COVID-19 infection aid in the diagnosis and proper timely management of this fatal disease.
Highlights
Corticosteroids are usually prescribed for severe cases with SARS-CoV-2 (COVID-19) who developed rapid oxygen desaturation [1]
Additional risk factors include uncontrolled diabetes mellitus and neutropenia with or without malignant diseases [2]. One of these side effects is serious, and even fatal is fulminant fungal infection that can damage the lungs or invade the maxillary sinuses rapidly spread to the orbital cavities and even intra-cranially [3, 4]
Corticosteroids played a very important role in the modulation of the immune-mediated lung damage caused by the COVID-19 virus and decreased human mortality [8]
Summary
Corticosteroids are usually prescribed for severe cases with SARS-CoV-2 (COVID-19) who developed rapid oxygen desaturation [1] Despite their importance to decrease patients’ mortality, they can cause harmful side effects, especially in immunocompromised patients. The authors aimed to highlight the importance of the early clinical and radiological diagnosis before the development of the notorious CT or MRI signs of bony destruction, orbital or intracranial invasion. This early diagnosis could eventually change the clinical decisions and hilariously modify the patients’ outcomes. Complimentary dedicated MRI and CT cuts over the left maxillary sinus showed localized signs of invasive fungal sinusitis without orbital or intracranial complications (Fig. 3). The patient did very well for the weeks after, and he did not need any further procedures
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