Rhino-orbital mucormycosis related to COVID-19- A case series exploring risk factors
Abstract There has been a surge of rhino-orbital mucormycosis cases in India in the wake of the second wave of the COVID-19 pandemic. It has been widely suggested that dysglycaemia due to diabetes present as a common comorbidity in these COVID-19 patients as well as indiscriminate steroid use has resulted in this surge. Here, we report a series of 13 cases of rhino-orbital mucormycosis in COVID-19 patients admitted at our center between mid-April and early June 2021. Out of the 13, the only common factor was COVID-19 at some time point before diagnosis of mucormycosis or coexistent with it. The cases showed a male preponderance and four of them showed intracranial extension of disease. Eleven of them had received steroids as part of COVID-19 management protocol and twelve of them had pre-existing or newly diagnosed diabetes. We have summarized other probable risk factors being considered such as immunosuppressed state, antiviral and Ayurvedic (Indian traditional) medications, oxygen therapy, with each of which we could not find a link of mucormycosis. We propose that COVID-19 itself through molecular mechanisms predisposes to mucormycosis, with other factors such as dysglycaemia providing a second hit.