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Brain & Heart

CASE REPORT
Clinical course and treatment challenges in post-

COVID-19 rhino-orbital-cerebral mucormycosis
in an immunocompetent host: A case report

Rajat Verma* , Awdhesh Yadav , and B. K. Ojha

Department of Neurosurgery, Kings George Medical University, Lucknow, Uttar Pradesh, India

Abstract

The aggressive and invasive nature of rhino-orbital-cerebral mucormycosis (ROCM)
in immunocompromised patients is well documented. However, this case report
aims to narrate its progression in an immunocompetent patient post-recovery from
COVID-19. This case report provides a glimpse into the patient’s journey through
multiple complications and painful surgeries inflicted by the disease. It emphasizes
the necessity of a multidisciplinary approach to overcome the challenges posed by
ROCM. In our patient, ROCM initially manifested with orbital cellulitis and paranasal
sinusitis, requiring exenteration and functional endoscopic sinus surgery. Within a brief
period, it advanced to the brain, resulting in a fungal abscess requiring craniotomy,
abscess excision, and excision of an infiltrated maxilla through hemimaxillectomy.
In addition, the exenteration and maxillectomy cavities were infiltrated by maggots,
requiring further debridement. At the time of writing, the patient was undergoing a
series of reconstructive surgeries to improve his social acceptability. While medical
*Corresponding author:
Rajat Verma management with surgical debridement remains the gold standard in the literature,
(vermarajat107@gmail.com) the extent of surgical debridement is still debated. Our case report not only
highlights the continuous need for radical surgical interventions, which often extend
Citation: Verma R, Yadav A, Ojha
BK. Clinical course and treatment to the next invaded organ but also reflects the prolonged hospital stay resulting from
challenges in post-COVID-19 serial reconstructive surgeries, which take a toll on the patient. In conclusion, good
rhino-orbital-cerebral mucormycosis teamwork with clinical foresight is required to achieve favorable treatment outcomes.
in an immunocompetent host:
A case report. Brain & Heart.
2024;2(2):2083.
doi: 10.36922/bh.2083 Keywords: Rhino-orbital-cerebral mucormycosis; Immunocompetent; COVID-19
Received: October 22, 2023
Accepted: January 2, 2024
Published Online: May 6, 2024 1. Introduction
Copyright: © 2024 Author(s). COVID-19 has emerged as one of the most formidable and challenging pandemics
This is an Open Access article of this decade, causing considerable morbidity and mortality worldwide. One of the
distributed under the terms of the insidious side effects of the virus is immunosuppression, which heightens susceptibility
Creative Commons Attribution
License, permitting distribution, to opportunistic infections. Zygomycetes, a group of fungi known for their invasive and
and reproduction in any medium, aggressive nature, pose a significant threat to immunocompromised patients, resulting
provided the original work is
properly cited. in a rise in cases of rhino-orbital-cerebral mucormycosis (ROCM).
Publisher’s Note: AccScience Before the COVID-19 pandemic, Mucorales primarily affected immunocompromised
Publishing remains neutral with individuals with conditions such as poorly controlled diabetes mellitus, hematological
regard to jurisdictional claims in
published maps and institutional disorders, chronic renal failure, organ transplant recipients, trauma and burns,
1
affiliations. malnutrition, immunosuppressive therapy, and malignancies . For example,

Volume 2 Issue 2 (2024) 1 doi: 10.36922/bh.2083