Rhino-Orbital Mucormycosis After a Workplace Accident in a Patient With Recent Covid-19: A Case Report

Mucormycosis is a rare disease that can cause deformities and has high mortality. It is caused by fungi of the order Mucorales, which are naturally found in the environment. The main risk factors are diabetes, neoplasms, immunosuppression, trauma, and more recently it has been associated with COVID-19. In this report, we describe a case of a patient with a recent history of COVID-19 who suffered a workplace accident and was diagnosed with rhino-orbital mucormycosis. A 37-year-old carpenter with class I obesity, hypertension, and diabetes developed COVID-19, was hospitalized, and used oral prednisone and low-flow oxygen. One month later, while at work, a wooden splinter penetrated his right eye. Two days later, he developed pain, periorbital edema, a nodule at the medial canthus of the right eye, and intermittent purulent discharge. CT showed “thickening and stranding of the right periorbital fat. Thickening and enhancement of the right globe and the right optic nerve. Right-sided inflammatory paranasal sinus disease.” He received two prolonged courses of antibiotics without improvement and underwent three surgical procedures. Histopathology then identified: “chronic inflammatory process with acute necrotizing exacerbation associated with fungal infection. The features of the fungal structures favor the class Zygomycetes (genus Mucormycosis).” Biopsy culture grew “Mucorales sp.” He progressed with amaurosis, optic neuritis, and cavernous sinus thrombosis. He underwent right orbital exenteration. He received lipid complex amphotericin B at 5 mg/kg/day. He was discharged on oral isavuconazole 200 mg once daily with outpatient follow-up. Control MRI no longer showed evidence of infection, in addition to complete symptom improvement. He evolved with full recovery of symptoms and returned to work, with guidance to use personal protective equipment. Mucormycosis is often difficult to diagnose. Its association with COVID-19 is still not well established; it has been reported that 93% of patients had the disease during hospitalization for COVID-19 and 8% had prior SARS-CoV-2 infection one to three months earlier, in a study across 18 countries. Workplace trauma constitutes a risk for infection. Treatment is based on two pillars: early surgical treatment and antifungal therapy. Sequelae are frequent and can be severe.