Rhino-orbital-cerebral Mucormycosis during Pandemic of COVID-19: A First Case Reported in Libya

Abstract

Mucormycosis is an unusual systemic infection caused by multicellular fungi. Despite,  few reports have been documented world widely, incidences of mucormycosis are recently increasing due to several predisposing factors such as diabetes, COVID-19 pandemic, and over prescription of corticosteroids. The clinical symptoms of this disease are often unfamiliar and vague. To the best of the authors’ knowledge, this is the first report that describes a case of clinical human mucormycosis during the COVID-19 pandemic in Libya. This report discusses also the risk factors and steps that can be applied to prevent occurrence of this disease. The patient is a 58-year-old Libyan female who presented with a history of COVID-19 infection, diabetes mellitus, hypertension, hypothyroidism, obesity, obstructive sleep apnea, and stable ischemic heart disease. She was complaining of loss of vision of the right eye, redness, and swelling all over the right face with scattered areas of blackish discoloration involving the inner third of the right eye and right face. Clinical examination showed bilateral basal and mid-lung fields fine crepitation, abdominal distension, severe chemosis, proptosis, restriction of all eye movement, aniscoria, upper lid ptosis and loss of corneal sensation of right eye. Computerized tomography (CT-Scan) of brain, para-nasal sinus, and orbit revealed right periorbital cellulitis, right eye proptosis, right ethmoidal, maxillary, sphenoidal sinusitis, and right cavernous sinus thrombosis without bone erosion. The histopathological report showed numerous broad branching aseptate hyphae and spores with acute cellulitis indicating an invasive fungal infection (mucormycosis). Mucormycosis is a rare fatal disease. Physician awareness and early management may significantly reduce mucormycosis severity.