Abstract
Introduction and importance
The impact of Covid-19 pandemic on the incidence and pattern of Mucormycosis (the black fungus), has increased sharply and is featured as an epidemic within a pandemic. The majority of cases were detected at late stages, which decreases the chances of survival.
Case presentation
The authors present a case of an immunocompetent male patient diagnosed with left orbital apex syndrome post covid-19 infection, which necessitated orbital exenteration. He was later hospitalized in a quarantine facility and an area of skin breakdown on his left cheek was noted and surgical debridement performed. Later, He presented to our institution with left hemifacial skin loss, exposing the underlying diseased bone. A multidisciplinary team examined the patient clinically and radiographically, reaching a primitive diagnosis of secondary cutaneous Mucormycosis due to rhino-orbital Mucormycosis, with no cavernous sinus thrombosis nor cranial extension. Radical surgical and medical treatments were given and he had an uneventful recovery. Unfortunately, he died 5 days after the reconstructive surgery with Anterolateral Thigh (ALT) flap.
Clinical discussion
The dual effect of both covid-19 and its' associated Mucormycosis, predispose patients to increased risk of pressure injuries including Medical device related pressure injuries. Survivors of Mucormycosis are high-risk patients, and planning their reconstruction by free flaps is challenging. However, delayed reconstruction is recommended.
Conclusion
Early diagnosis and management of covid-19 associated Mucormycosis should be prioritized. Moreover, surgical debridement of necrotic tissues should not be delayed due to an unavailable or negative histopathology.
Medical device related pressure injuries (MDRPIs) is an iatrogenic injury, and its prevention and management should be prioritized.
Mucormycosis should be investigated in COVID-19 infected and recovered patients.
Cutaneous Mucormycosis is common among the immunocompetent patients, and knowledge of its types and subtypes is essential.
The authors highlight the value of clinical and radiographic investigation in aiding early diagnosis of Mucormycosis.
Surgical debridement of necrotic tissues is a life-saving measure, and should not be delayed due to an unavailable or negative histopathology.
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