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Case report
COVID-19 triggering mucormycosis in a susceptible patient: a new phenomenon in the developing world?
  1. Shweta Mallikarjun Revannavar,
  2. Supriya P S,
  3. Laxminarayana Samaga and
  4. Vineeth V K
  1. General Medicine, Nitte University K S Hegde Medical Academy, Mangalore, Karnataka, India
  1. Correspondence to Dr Shweta Mallikarjun Revannavar; shweta.connect2{at}gmail.com

Abstract

A middle-aged woman with diabetes presented with left-sided facial pain, complete ptosis and fever of short duration. On presentation, she had hyperglycaemia without ketosis. There was total ophthalmoplegia of the left eye with a visual acuity of 6/36. She incidentally tested positive for COVID-19. CT paranasal sinus and MRI brain revealed left-sided pansinusitis with acute infarct in the left parieto-occipital region without angioinvasion. An emergency functional endoscopic sinus procedure was done, which confirmed mucormycosis on histopathological examination. After 1 week of conventional amphotericin B and antibiotics, repeat CT brain showed improvement in mucosal thickening and sinusitis. This case is a rare presentation of mucormycosis associated with rapid progression to orbital apex syndrome with brain infarction in a patient with non-ketotic diabetes and COVID-19. Early diagnosis and treatment are essential to prevent further end-organ damage. It is also interesting that there was no angioinvasion and transient periarterial inflammation was attributed to brain infarction.

  • COVID-19
  • diabetes
  • tropical medicine (infectious disease)
  • stroke

This article is made freely available for use in accordance with BMJ’s website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.

https://bmj.com/coronavirus/usage

https://doi.org/10.1136/bcr-2021-241663

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    Footnotes

    • Twitter @ShwetaMR

    • Contributors All four authors were involved in patient care directly. Writing the initial manuscript was done by SMR. Selecting appropriate image templates was done by VVK. The necessary corrections and final outcome of the article were done under the guidance of SPS and LS.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.