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Rhino-orbital mucormycosis following COVID-19 in previously non-diabetic, immunocompetent patients
Akshay Gopinathan Nair1,2,3,4, Namrata G Adulkar5, Lynn D'Cunha1
1Department of Ophthalmology, Lokmanya Tilak Municipal Medical College & General Hospital, Sion, Mumbai, India.
Purpose:
To report a series of 13 immunocompetent patients who developed new-onset uncontrolled diabetes mellitus (DM) following COVID-19 infection and presented as rhino-orbital mucormycosis (ROM).
Method:
Retrospective study.
Results:
A total of 127 patients of COVID-19 Associated Mucormycosis (CAM) were evaluated at four centres in India. All patients underwent endoscopic sinus debridement surgery and received systemic amphotericin-B therapy. Five patients (5/13; 38.4%) received retrobulbar amphotericin-B injections. Orbital exenteration was performed in advanced orbital involvement or progression of orbital disease in spite of maximal medical therapy. In his cohort, 13/127 (10.2%) patients presented with new onset DM, where one patient had bilateral disease. The mean age was 35.9 years (range: 20-51 years) and the mean duration from diagnosis of COVID-19 to the diagnosis of mucormycosis was 14.2 days. While 7/13 (53.8%) of the patients received systemic corticosteroids during the course of their treatment for COVID-19, six patients received no steroids or immunomodulators. The mean follow-up period was 9.2 weeks (range: 3-18 weeks) following discharge. Life salvage was possible in 100% of the cases. While overall globe salvage was possible in 42.8% (6/14 eyes), the globe could be preserved in 4/5 patients who received retrobulbar amphotericin-B injections.
Conclusions:
Those involved in the care of COVID-19 patients should be aware about the possibility of recent-onset DM, even in patients without a history of corticosteroid therapy. Rarely, recent-onset DM following COVID-19 may present as rhino-orbital mucormycosis, which requires aggressive surgical and medical intervention.
Insights
COVID-19 can rarely lead to new-onset diabetes mellitus (DM), sometimes presenting as rhino-orbital mucormycosis (ROM). Early recognition and aggressive treatment are crucial for patient survival.
Area of Science:
- Infectious Diseases
- Endocrinology
- Ophthalmology
Background:
- COVID-19 has been associated with various complications.
- Mucormycosis, a serious fungal infection, has seen a rise in cases linked to COVID-19.
- New-onset diabetes mellitus is a recognized complication, but its presentation with mucormycosis is rare.
Purpose of the Study:
- To describe a series of 13 immunocompetent patients.
- To highlight new-onset uncontrolled diabetes mellitus (DM) following COVID-19 infection.
- To report presentation as rhino-orbital mucormycosis (ROM).
Main Methods:
- Retrospective study design.
- Evaluation of 127 patients with COVID-19 Associated Mucormycosis (CAM).
- Analysis of a specific cohort of 13 patients with new-onset DM.
Main Results:
- 10.2% of CAM patients (13/127) presented with new-onset DM.
- Mean age was 35.9 years; DM diagnosis occurred 14.2 days post-COVID-19.
- Life salvage was 100%; globe salvage was 42.8%, improved with retrobulbar amphotericin-B.
Conclusions:
- Awareness of new-onset DM post-COVID-19 is essential, even without prior steroid use.
- Rhino-orbital mucormycosis can be a rare presentation of post-COVID-19 DM.
- Aggressive surgical and medical interventions are necessary for managing this condition.
