Abstract
Introduction:
India is currently experiencing a detrimental surge in mucormycosis cases in the background of COVID-19. We present a case of fungal osteomyelitis and sinusitis due to invasive mucormycosis with orbital invasion in a post-COVID-19 patient.
Case Presentation:
A 42-year-old female with a past medical history significant for Type 2 diabetes mellitus and COVID-19 presented with complaints of sudden onset left-sided frontotemporal headache associated with blurring of vision, non-projectile vomiting, and toothache. MRI Brain with paranasal sinuses suggestive of invasive sinusitis involving left maxillary sinus with a focal breach in the bony walls. The patient underwent endoscopic modified medial maxillectomy and started with liposomal amphotericin B. A biopsy specimen study confirmed a diagnosis of invasive mucormycosis. Postoperative CT facial bones revealed the extension of inflammatory changes to medial and lateral pterygoid muscles, involvement of infraorbital nerve, inferior rectus, oblique muscles, and palatal process of left hemi maxilla requiring infrastructural maxillectomy after endoscopic clearance.
Discussion:
Mucormycosis is an invasive fungal infection, first described by Fürbinger in 1876. The fungal spores are transmitted through inhalation, ingestion, or direct inoculation. The universal risk factor is diabetes. According to Global guideline for the diagnosis and management of mucormycosis, any diabetic patient with facial pain, sinusitis, proptosis, ophthalmoplegia, or newly diagnosed amaurosis, is at risk of mucormycosis and warrants a Cranial CT or MRI of the head. Treatment duration is determined by the resolution of imaging findings and immune status of the patient. Surgical debridement with clean margins should be achieved in parallel to antifungal treatment.
Conclusion:
We intend to express the increased need for alertness among practitioners for early diagnosis of mucormycosis among patients with a history of COVID-19, especially when they have additional risk factors causing immunosuppression.
