Successful Treatment of Acute Invasive Rhino-Orbito-Cerebral Mucormycosis Associated with COVID -19: Case Report and Literature Review

Background and Aim: Mortality associated with post-coronavirus disease 2019 (COVID-19) rhino-orbital cerebral mucormycosis (ROCM) is an evolving concern. Association of COVID-19, corticosteroid therapy, and uncontrolled diabetes mellitus (DM) are considered predisposing factors for ROCM. We present two cases of successful treatment leading to patient survival for post-COVID-19, stage 4c-ROCM. Case Presentation: Two middle-aged men with poorly controlled DM were referred to our hospital for post-COVID-19 ROCM. They had received intravenous antivirals and dexamethasone as treatment in a primary center. Both patients had unilateral oculofacial pain and swelling followed by acute visual loss, unilateral proptosis, facial palsy, and trigeminal hypoesthesia. A computed tomography scan revealed opacity and bony erosion of paranasal sinuses (PNS). Obtained specimens confirmed mucormycosis agent on histopathological examination. After the failure of conservative treatments, retrobulbar injections of liposomal-amphotericin B, PNS debridement, and orbital exenteration, both patients developed blurred consciousness owing to the extension of the infection into the intracranial cavity. Brain magnetic resonance imaging revealed a right frontal lobe abscess in case 1 and a left frontal sinus abscess and involvement in case 2. Both underwent transcranial debridement and resection of necrotic tissue and drainage of the abscess. At follow-up, the patients were in good condition, and the fungal cultures were negative for mucormycosis agents. Conclusion: ROCM may be a complication of COVID-19 in high-risk patients. Control of the patient’s underlying systemic condition and prompt treatment with antifungal agents, along with timely aggressive resection of cerebral abscess and necrotic paranasal tissues, are the mainstays of management for ROCM.