Sinonasal Mucormycosis in a post Covid patient - first case in Sri Lanka

The Covid 19 infection which is caused by  severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is found to be associated with a wide range of bacterial and fungal co-infections. We report the first post COVID-19 Sino-orbital Mucormycosis infection in a patient with diabetes mellitus in Sri Lanka. A 57 years old female with a history of long standing uncontrolled diabetes presented with left facial pain and swelling. She has had  a positive reverse-transcriptase polymerase chain reaction (RT-PCR) for SARS-CoV-2 one month back. On Rigid nasal endoscopy (RNE) blackish crusting was noted on the nasal septum. The Contrast enhanced CT scan (CECT) demonstrated fat stranding in premaxillary, infratemporal and pterygopalatine regions. Presence of mucormycosis was confirmed  from biopsies following a functional endoscopic sinus procedure. Patient was treated with IV liposomal amphotericin B and with local nasal packs with amphotericin. Sinonasal biopsies after completion of 5g of Liposomal amphotericin B were negative and the patient was asymptomatic and discharged after 27 days of Amphotericin. 

Conclusion: A good prognosis can be achieved with an early diagnosis and debridement along with prompt conservative treatment of Amphotericin B.