A Case of Post-COVID Mucormycosis in a Diabetic Patient in Pakistan

Mucormycosis is a rare but potentially fatal angioinvasive fungal infection, caused by filamentous molds of the order Mucorales, which primarily affects immunocompromised individuals and is characterized by high mortality rates. Diabetes mellitus (DM) is the most common risk factor for mucormycosis. During the COVID-19 pandemic, the number of cases significantly increased. Mucormycosis may present in several clinical forms, but the most common form is the rhinocerebral form. This case report aims to emphasize the severity of mucormycosis in a patient with uncontrolled DM who recently recovered from COVID-19. Furthermore, this study demonstrates the importance of early diagnosis and proper treatment to prevent fatal progression. A 58-year-old man is presented in our case report; the patient was recently diagnosed with DM and presented to the outpatient department (OPD) with complaints of right eye ptosis and progressively worsening painful vision loss over 10 days. He had been infected with SARS-CoV-2 infection 15 days earlier and was treated at home with systemic corticosteroids and antibiotics. One week after recovery, he experienced spontaneous nasal bleeding, followed by progressive ocular symptoms that culminated in restricted eye movement and complete vision loss in the right eye. Physical examination revealed right eye proptosis and no light perception. Laboratory tests indicated an elevated C-reactive protein (CRP) level of 25.65 mg/dL and a significantly high glycated hemoglobin A1c (HbA1c) level of 16.3%. A tissue biopsy showed inflammatory nasal polyps associated with mucormycosis. The patient was promptly treated with insulin in order to control the elevated HbA1c and amphotericin B to stop the fungal infection and underwent extensive surgical excision. Our case highlights the severity of mucormycosis in a patient with uncontrolled DM who recently recovered from COVID-19 and shedding light on the importance of controlling the DM in order to reduce the negative impacts on the patient's health. The patient underwent proper treatment with antifungals and aggressive surgical excision to prevent more invasion of the fungi. Despite that, neurological deficits persist including complete loss of vision in one eye which reflects the importance of early diagnosis and proper management to prevent fatal progression.