Rhino-orbital mucormycosis with palatal involvement: series of four cases

Abstract

Mucormycosis (Zygomycosis) is a rare, opportunistic fungal infection caused by mucorales.­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­ The clinical hallmark of invasive mucormycosis is angioinvasion and subsequent thrombosis. Palate is the least common site and ulceration with palatal perforation is late occurrence. Involvement of oral cavity usually appears as palatal ulceration or necrosis with denudation of bone and later perforation of palate. In our cases, the patients had both debilitating conditions resulting from poorly controlled diabetes and acute inflammatory immune response due to COVID-19 infection. Radiographically opacification of sinuses may be observed in conjunction with patchy effacement of bony walls of sinuses. Potassium hydroxide smear of lesion can reveal non septate fungal hyphae. Culture on sabouraud’s dextrose agar is preferred but histopathological examination of biopsy specimen is conclusive. Successful treatment of mucormycosis consists of rapid diagnosis of the condition followed by radical surgical debridement of infected necrotic tissue with systemic administration of antifungal drugs. Mucormycosis, along with other deep fungal infections, should be considered as an important outcome of SARS-CoV-2 infection.