Unilateral optic neuritis with contralateral central retinal artery and central retinal vein occlusion in a post-COVID-19 case of rhino-orbital-cerebral mucormycosis: An unusual presentation

Abstract

Introduction: The corona virus disease (COVID)-19 is a severe acute respiratory syndrome (SARS-CoV-2) which is posing a great threat to mankind and has been associated with a high risk of opportunistic fungi infection presenting as rhino-orbital-cerebral-mucormycosis. We report a rare and never reported case of unilateral optic neuritis with contralateral central retinal artery (CRA) and central retinal vein (CRV) occlusion in a patient of post-COVID-19 rhino-orbital-cerebral-mucormycosis. Case Report: A 45-year-old diabetic, Indian gentleman reported to our clinic in Dehradun, Uttarakhand, India with complaints of bilateral diminution of vision in right eye (RE) five days and left eye (LE) five weeks duration. He provided recent history of COVID-19 infection for which he was hospitalized and treated. Fundus examination confirmed optic neuritis in right eye and a combined established central retinal artery and vein occlusion in left eye. Fundus fluorescein angiography, visual evoked potential, and magnetic resonance imaging (MRI) were crucial in clinching the diagnosis. Conclusion: Rhino-orbital-cerebral-mucormycosis invades tissue through multiple routes. However, it is extremely rare to see a combination of angioinvasion leading to visual loss in one eye and perineural spread leading to optic neuritis and visual loss in the contralateral eye. Clinicians must be aware of such rare presentations which could serve as benchmark in diagnosis and treatment.