Immunosuppression is a Double-Edged Sword in COVID-19 Treatment: a Case Report of Rhino-Orbito-Cerebral Mucormycosis.

ABSTRACT

BACKGROUND: Mucormycosis is a life-threatening fungal infection mostly occurring in immunosuppressed patients such as organ transplant or diabetic patients. In this paper, we described a case of COVID-19 with rhino-orbito-cerebral mucormycosis. METHODS: The nucleic acid amplification test (NAAT) from a nasopharyngeal sample for SARS-CoV-2 was done. Demographic data, biochemical tests, paranasal sinuses (PNS) CT scan, brain CT scan, chest CT scan, and palate biopsy were performed. RESULTS: The NAAT was positive for SARS-CoV-2. PNS CT scan revealed mucosal thickening of all paranasal sinuses, brain CT scan showed hypodense area in antero-inferior cortex, and chest CT scan revealed diffuse ground glass opacity in favor of COVID-19 infection. Palate biopsy revealed fibroconnective tissue with broad pauciseptated ribbon-like hyphae. CONCLUSIONS: In this paper, a case of COVID-19 with rhino-orbito-cerebral mucormycosis was described. The treatment with immunosuppressive drugs predisposed this patient to secondary fungal infection. Immunosuppression is a double-edged sword in COVID-19 treatment and immunosuppressive drugs should be prescribed only in severely ill patients and for a short period.