The COVID-19 Pandemic and the Escalation of Rhino-Orbital-Cerebral Mucormycosis: A Retrospective Review

Background: The COVID-19 pandemic has contributed to a surge in secondary opportunistic infections, notably rhino-orbital-cerebral mucormycosis (ROCM) a rare but aggressive fungal infection. Its emergence, particularly in individuals with immunosuppressive conditions such as uncontrolled diabetes or corticosteroid exposure, poses serious clinical challenges. Objective: This study aimed to characterize the demographic and clinical profiles of post-COVID-19 patients with ROCM, evaluate medical and surgical interventions, identify key prognostic factors such as diabetes, steroid use, and intracranial involvement. Methodology: A retrospective analysis was conducted on 68 patients diagnosed with ROCM at Saidu Group of Teaching Hospitals, Swat, Pakistan, between January 2021 and August 2024. Data on demographics, comorbidities, COVID-19 history, clinical presentation, disease extent, surgical interventions, and outcomes were collected. Statistical tests were applied to identify predictors of mortality. Results: Of the 68 patients, 61% were male, aged 35–73 years. Diabetes mellitus was present in 91.17%, and 88.3% had a recent history of COVID-19. Hemifacial pain, orbital complications, and vision loss were common. All patients underwent surgical debridement 88.23% via modified endoscopic Denker’s approach. The mortality rate was 32.3%, while 62% achieved disease-free status. Intracranial extension (p<0.001) and uncontrolled diabetes (p=0.016) were significantly associated with mortality. Steroid use showed a non-significant trend (p=0.12). Conclusion: COVID-19-associated ROCM predominantly affected diabetic males and presented with aggressive, multisystem involvement. Despite surgical and antifungal management, mortality remained high. Early diagnosis, strict glycemic control, and multidisciplinary care are critical for improving outcomes. Further research should focus on rapid diagnostics and optimized treatment strategies to mitigate the burden of this life-threatening condition.