Mixed infection of rhino-orbito-cerebral mucormycosis and aspergillosis with culture proven aspergillus endophthalmitis in a post covid patient- A case report

Abstract

Rhino orbito cerebral mucormycosis has become very common in this covid pandemic. Fungal endophthalmitis is also being increasingly reported. All fungal infections may not be just mucor. This is to report a case of rhino orbito cerebral mucormycosis and aspergillosis with aspergillus endophthalmitis, in a post covid patient who had required intensive care during covid illness. A post covid 73 years old female with type 2 diabetes mellitus and hypertension presented with sudden onset painful loss of vision in right eye with right sided headache. Anterior segment examination showed a streak hypopyon with fundus showing severe vitritis. Diagnostic nasal endoscopy and radiological features were suggestive of probable rhino orbital mucor mycosis, Patient was started on systemic amphotericin B with intravitreal and retro orbital amphotericin. The KOH mount and culture of the vitreous aspirate showed aspergillus while the histopathology of the sinus tissue revealed mucor along with aspergillus. Fungal endophthalmitis is making an appearance in a big way in this covid pandemic Early diagnosis and proper treatment is the only way to defend against these life-threatening fungi. Diagnostic nasal endoscopy with biopsy and vitreous tap for culture as well as histopathology taken before initiating treatment will go a long way in making a correct diagnosis.