Publication

Abstract : A 56-year-old male with acute-onset fever was diagnosed with coronavirus disease 2019 (COVID-19) pneumonitis on the basis of reverse transcriptase-polymerase chain reaction test and High resolution computed tomography findings revealed a score of 12/25). The blood parameters showed leukocytosis with a total leukocyte count of 17 × 103/mm3. Neutrophil count was 14.2 × 103/mm3 [83.8%] and lymphocyte count was 1.1 × 103/mm3 [6.5%]. Serum C-reactive protein was elevated (45 mg/dl). The glycosylated haemoglobin level was 11.9%, and the random blood sugar value was 194 mg/dl. Renal functions were within normal limits. Apart from the intravenous antibiotics and antiviral medicines, the patient was treated with intravenous steroids (IV solumedrol 20 mg). The patient however complained of nasal congestion on the 24th day of his initial symptoms. Non-contrast coronal T2 weighted magnetic resonance images without fat suppression (Figure 1A) and with fat suppression (Figure 1B) showed focal sino-nasal mucosal thickening with T2 dark signal in the superior nasal cavity (marked as *) and osteo-meatal complex on the right side (black arrow). Mild mucosal thickening is also seen in the right frontal, maxillary and ethmoid sinuses along with left-sided concha bullosa. The right middle (white arrow) and inferior meatus (white triangle) showed T2 dark signal changes along with thinning, more prominently in the middle meatus. Normal T2 bright signal was seen in the middle and inferior turbinates on the left side. The findings raise suspicion about mucormycosis, which was promptly confirmed on nasal endoscopy (Figure 1C). The patient was treated with intravenous Amphotericin and endoscopic sinus decompression and turbinectomy.