Rhino-Orbital-Cerebral Mucormycosis With Bilateral Endogenous Aspergillus Endophthalmitis Following Steroid Therapy for COVID-19 Infection.

Abstract

Purpose: We report a diabetic patient with rhino-orbital-cerebral mucormycosis (ROCM) and bilateral endogenous Aspergillus endophthalmitis post-coronavirus disease 2019 (COVID-19) infection.

Case report: A 45-year-old man who had diabetes experienced vision loss and sought medical assistance. Prior to developing orbital symptoms, he had undergone intensive corticosteroid therapy for COVID-19. His uncorrected visual acuity was 20/20 in the right eye, but he had no light perception in his left eye. While hospitalized for ROCM, he developed endogenous endophthalmitis in his left eye, which was caused by Aspergillus fumigatus. Additionally, Aspergillus retinitis was diagnosed in his right eye due to the development of white retinal lesions and preretinal hemorrhage. To treat ROCM, he received systemic and retrobulbar injections of amphotericin B, which led to regression. Posaconazole was prescribed for the treatment of Aspergillus endophthalmitis. The retinitis lesions in his right eye responded well to oral posaconazole without any long-term complications.

Conclusion: Patients with COVID-19-associated immunodeficiency may be more vulnerable to opportunistic pathogens, such as mucormycosis and Aspergillus, particularly if they have comorbidities like diabetes mellitus. It is also possible for one person to be coinfected with multiple opportunistic pathogens.