AccScience Publishing / BH / Volume 2 / Issue 2 / DOI: 10.36922/bh.2083

Clinical course and treatment challenges in post-COVID-19 rhino-orbital-cerebral mucormycosis in an immunocompetent host: A case report

Rajat Verma1* Awdhesh Yadav1 B.K. Ojha1
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1 Department of Neurosurgery, Kings George Medical University, Lucknow, Uttar Pradesh, India
Brain & Heart 2024, 2(2), 2083
Submitted: 22 October 2023 | Accepted: 2 January 2024 | Published: 6 May 2024
© 2024 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution 4.0 International License ( )

The aggressive and invasive nature of rhino-orbital-cerebral mucormycosis (ROCM) in immunocompromised patients is well documented. However, this case report aims to narrate its progression in an immunocompetent patient post-recovery from COVID-19. This case report provides a glimpse into the patient’s journey through multiple complications and painful surgeries inflicted by the disease. It emphasizes the necessity of a multidisciplinary approach to overcome the challenges posed by ROCM. In our patient, ROCM initially manifested with orbital cellulitis and paranasal sinusitis, requiring exenteration and functional endoscopic sinus surgery. Within a brief period, it advanced to the brain, resulting in a fungal abscess requiring craniotomy, abscess excision, and excision of an infiltrated maxilla through hemimaxillectomy. In addition, the exenteration and maxillectomy cavities were infiltrated by maggots, requiring further debridement. At the time of writing, the patient was undergoing a series of reconstructive surgeries to improve his social acceptability. While medical management with surgical debridement remains the gold standard in the literature, the extent of surgical debridement is still debated. Our case report not only highlights the continuous need for radical surgical interventions, which often extend to the next invaded organ but also reflects the prolonged hospital stay resulting from serial reconstructive surgeries, which take a toll on the patient. In conclusion, good teamwork with clinical foresight is required to achieve favorable treatment outcomes.

Rhinoorbitalcerebral mucormycosis
  1. Bodenstein NP, McIntosh WA, Vlantis AC, Urquhart AC. Clinical signs of orbital ischemia in rhino-orbitocerebral mucormycosis. Laryngoscope. 1993;103:1357-1361. doi: 10.1288/00005537-199312000-00007


  1. Chakrabarti A, Das A, Mandal J, et al. The rising trend of invasive zygomycosis in patients with uncontrolled diabetes mellitus. Med Mycol. 2006;44:335-342. doi: 10.1080/13693780500464930


  1. Kauffman CA. Zygomycosis: Reemergence of an old pathogen. Clin Infect Dis. 2004;39:588-590. doi: 10.1086/422729


  1. Chakrabarti A, Das A, Sharma A, et al. Ten years’ experience in zygomycosis at a tertiary care centre in India. J Infect. 2001;42:261-266. doi: 10.1053/jinf.2001.0831


  1. Ribes JA, Vanover-Sams CL, Baker DJ. Zygomycetes in human disease. Clin Microbiol Rev. 2000;13:236-301. doi: 10.1128/CMR.13.2.236


  1. Roden MM, Zaoutis TE, Buchanan WL, et al. Epidemiology and outcome of zygomycosis: A review of 929 reported cases. Clin Infect Dis. 2005;41:634-653. doi: 10.1086/432579


  1. Spellberg B, Edwards J Jr., Ibrahim A. Novel perspectives on mucormycosis: Pathophysiology, presentation, and management. Clin Microbiol Rev. 2005;18:556-569. doi: 10.1128/CMR.18.3.556-569.2005


  1. Singh V, Singh M, Joshi C, Sangwan J. Rhinocerebral mucormycosis in a patient with type 1 diabetes presenting as toothache: A case report from Himalayan region of India. BMJ Case Rep. 2013;2013:bcr2013200811. doi: 10.1136/bcr-2013-200811


  1. Sen M, Honavar SG, Bansal R, et al. Epidemiology, clinical profile, management, and outcome of COVID-19-associated rhino-orbital-cerebral mucormycosis in 2826 patients in India - Collaborative OPAI-IJO study on Mucormycosis in COVID-19 (COSMIC), report 1. Indian J Ophthalmol. 2021;69(7):1670-1692. doi: 10.4103/ijo.IJO_1565_21


  1. Shatriah I, Mohd-Amin N, Tuan-Jaafar TN, Khanna RK, Yunus R, Madhavan M. Rhino-orbito-cerebral mucormycosis in an immunocompetent patient: Case report and review of literature. Middle East Afr J Ophthalmol. 2012;19:258-261. doi: 10.4103/0974-9233.95269


  1. Fairley C, Sullivan TJ, Bartley P, Allworth T, Lewandoski R. Survival after rhino-orbital-cerebral mucormycosis in an immunocompetent patient. Ophthalmology. 2000;107:555-558. doi: 10.1016/s0161-6420(99)00142-6


  1. Garcia-Covarrubias L, Bartlett R, Barratt DM, Wassermann RJ. Rhino-orbitocerebral mucormycosis attributable to Apophysomyces elegans in an immunocompetent individual: Case report and review of the literature. J Trauma. 2001;50:353-357. doi: 10.1097/00005373-200102000-00027


  1. Chakrabarti A, Ghosh A, Prasad GS, et al. Apophysomyces elegans: An emerging zygomycete in India. J Clin Microbiol. 2003;41:783-788. doi: 10.1128/JCM.41.2.783-788.2003


  1. Rao SS, Naresh KP, Pragache G, Chakrabarti A, Saravanan K. Sinoorbital mucormycosis due to Apophysomyces elegans in immunocompetent individuals--an increasing trend. Am J Otolaryngol. 2006;27:366-369. doi: 10.1016/j.amjoto.2006.01.002


  1. Schütz P, Behbehani JH, Khan ZU, et al. Fatal rhino-orbito-cerebral zygomycosis caused by Apophysomyces elegans in a healthy patient. J Oral Maxillofac Surg. 2006;64:1795-1802. doi: 10.1016/j.joms.2006.05.010


  1. Bhadani PP, Bhadani UK, Thapliyal N, Sen R. A rare presentation of invasive rhino-orbital mucormycosis in an immunocompetent young girl: A case report. Indian J Pathol Microbiol. 2007;50:785-786.


  1. Baradkar VP, Mathur M, Taklikar S, Rathi M, Kumar S. Fatal rhino-orbito-cerebral infection caused by Saksenaea vasiformis in an immunocompetent individual: First case report from India. Indian J Med Microbiol. 2008;26:385-387. doi: 10.4103/0255-0857.43572
Conflict of interest
The authors declare no conflicts of interest.
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Brain & Heart, Electronic ISSN: 2972-4139 Published by AccScience Publishing