COVID-19 Associated Rhino-Orbital-Cerebral Mucormycosis: A Case Series

Rhino-orbital-cerebral mucormycosis is a unique secondary infection of COVID-19 pneumonia. We reported 2 cases diagnosed with COVID-19 pneumonia with polymerase chain reaction (PCR) test, presented with orbital swelling and ptosis without any nasal symptoms. Both patients were immunocompetent, except with a history of prolonged use of oral glucocorticoid as part of COVID-19 pneumonia treatment. Contrast-enhanced computed tomography noted skull base osteomyelitis and temporal subdural empyema. They were diagnosed with mucormycosis by either fungal PCR or tissue histopathology examination that shown to have fungal hyphae. Both cases have resolution of the symptoms after surgical debridement and at least 6 weeks of antimicrobial therapy. We discuss the contributary factors of second-ary fungal infection related to COVID-19 as well as the uniqueness in these cases in term of clinical presentations and the disease progression.