Table 1.
Clinical profile, treatment and outcome of our case series and previously reported cases of mucormycosis with COVID-19 infection.
| Case/Author | Age/sex | Comorbidity | Clinical manifestations | Imaging | HPE | Treatment | Outcome |
|---|---|---|---|---|---|---|---|
| Case 1 | 59/F | T2DM, HTN | Headache, ptosis, chemosis, mild proptosis, loss of vision, complete ophthalmoplegia, blackish discharge from nasal cavity, black crust on hard palate | Bilateral maxillary, ethmoid, left frontal and sphenoid sinusitis, cavernous sinus thrombosis. | LCB/KOH mount of nasal discharge showed aseptate filamentous fungal hyphae, suggestive of rhizopus and confirmed on culture | Liposomal amphotericin B, antibiotics, Inotropes, MV | Deceased |
| Case 2 | 52/M | T2DM | Headache, diminished vision, mild proptosis, chemosis, mild restriction of ocular movement of right eye. blood tinged black discharge from nasal cavity | Right orbital cellulitis, right maxillary sinus, bilateral ethmoid & sphenoid sinusitis | LCB mount of nasal discharge revealed rhizopus arrhizus, cotton wool-like white growth on culture | Liposomal amphotericin B, antibiotics, posaconazole | Follow-up |
| Case 3 | 62/F | T2DM, HTN | Loss of vision, periorbital swelling, lid edema, black patches on lids of right eye, blood-tinged discharge from nasal cavity, black crust on hard palate | Pansinusitis, right orbital cellulitis, endophthalmitis, cavernous sinus thrombosis | KOH mount of nasal scraping revealed rhizopus | Liposomal amphotericin B, antibiotics | Hospitalized |
| Case 4 | 70/F | T2DM | Decreased vision, diplopia, lid edema, chemosis, mild proptosis, ophthalmoplegia of left eye, black crust in nasal cavity | Left orbital cellulitis, erosion of medial wall-floor of left orbit and pansinusistis (L > R) | LCB mount of nasal scraping and sabouraud dextrose agar culture revealed rhizopus arrhizus | Liposomal amphotericin B, antibiotics, supportive | Hospitalized |
| Case 5 | 68/F | T2DM | headache, facial swelling, ptosis, lid edema, loss of vision, proptosis and complete ophthalmoplegia of right eye, blood-tinged black discharge from nostrils & black crust on hard palate | Right pre and post septal orbital cellulitis with endo-ophthalmitis, right cavernous thrombosis, multiple lacunar infarcts and pansinusitis | LCB & KOH mount of nasal scraping and culture revealed rhizopus arrhizus | Liposomal amphotericin B, antibiotics, Inotropes, supportive | Deceased |
| Werthman et al. | 33/F | HTN/Asthma | Left-sided ptosis, proptosis, complete ophthalmoplegia and altered sensorium, DKA | Maxillary & ethmoidal sinusitis, MRI brain showed multiple areas of infarction and ischemia | Culture of nasal mucosal swab | Lateral canthotomy, sinus debridement & amphotericin B |
Deceased |
| Mehta et al. | 60/M | DM | Proptosis, chemosis, periorbital edema, soft tissue necrosis of lids of right eye. Fixed dilated left eye | Right frontal, maxillary, & ethmoidal sinusitis. Retrobulbar soft tissue swelling mild proptosis on right side | Nasal biopsy from the middle turbinate, confirmed by culture | Amphotericin B, inotropes, MV | Deceased |
| Silvino et al. | 86/M | HTN | Diarrhea, melena, abdominal tenderness, and severe anemia | Two giant gastric ulcers with dirty debris & deep hemorrhagic base on greater and lesser curvature on EGD | Biopsy of gastric ulcer (HE stain) | PRBC transfusion, Inotropes, MV | Deceased Before DX |
HPE, Histopathology examination; F, Female; M, Male; T2DM, Type 2 Diabetes mellitus; HTN, Hypertension; DKA, Diabetic ketoacidosis; L, Left; R, Right; LCB, Lactophenol cotton blue; KOH, Potassium hydroxide; MV, Mechanical ventilation; DM, Diabetes mellitus; EGD, Esophagogastroduodenoscopy; PRBC, Packed red blood cell; HE, Hematoxylin and eosin; Dx, Diagnosis; NA, Not available.