Pooja Das
Mucor is a saprophytic organism and commonly invades the nose and paranasal sinuses of immunocompromised & diabetic patients. Mucormycosis is characterized by rapid development of tissue necrosis as a result of vascular invasion. Diagnosis based on strong clinical suspicion with radical debridement under amphotericin cover offers a good management option. A 39 year old male presented with complaint of loose upper teeth, swelling of left cheek and facial pain since 3 months. He was COVID 19 positive 3 months back. Patient is a known case of uncontrolled type 2 DM. On examination multiple pus draining sinuses were observed in left upper gingivae, pus culture sensitivity, KOH mount and fungal culture was sent. Fungal culture revealed growth of aseptate hyphae (Mucor). He was posted for FESS and surgical debridement of left maxillary sinus. Pre-operatively patient was started with Tab. Iatroconazole 200 mg BD and was under cover of Inj Liposomal Amphotericin B with nasal douching post-operatively. Post-operative period remained uneventful, and on routine endoscopic examination healthy mucosa of maxillary sinus was noted. Mucormycosis is a severe fungal infection encountered in a recent COVID recovered patient. This case highlights that COVID infection can impair the immune response thus exposing patients to higher risk of developing opportunistic infections with worst outcomes. Mucormycosis is a serious opportunistic fungal infection caused by fungi from the Mucorales family, with Rhizopus species being the most prevalent causal pathogen. Immunocompromised patients, particularly those with uncontrolled diabetes mellitus or haematological malignancies, are the most susceptible to infection. It is known to be one of the most rapidly progressing forms of fungal infection in humans, with a high fatality rate. Patients infected with the coronavirus 2 of the severe acute respiratory syndrome (SARS-CoV-2) develop coronavirus disease (COVID-19), which is associated with significant and long-term lymphopenia, affecting the immune system. Although the link between COVID-19 and Mucormycosis is unexpected, it is not shocking. Because down-regulation of the immune system, particularly in uncontrolled diabetes mellitus, is a key risk factor for Mucormycosis and is also a high-risk factor for COVID-19. Second, steroids, which are known to inhibit immunity, are a therapy option that has been demonstrated to reduce COVID-19 mortality. As a result, the combination of COVID-19, reduced immunity, and steroids is likely to predispose a patient to Mucormycosis. We present six cases of paranasal mucormycosis associated with previous Covid-19 infection who presented to the Department of ENT.
