Rhino-orbito-cerebral mucormycosis: an epidemic in a pandemic

BACKGROUND: Opportunistic cases of rhino-orbito-cerebral mucormycosis (ROCM) have increased in India during the coronavirus disease 2019 (COVID-19) pandemic. AIM: To study laboratory parameters, histopathological features of sinus mucosal biopsies and exenterated orbit specimens, and clinical aspects of patients with ROCM. MATERIALS AND METHODS: Retrospective analysis of nasal and sinus debridement biopsies and orbital exenteration specimens of 30 patients was undertaken, along with analysis of laboratory parameters, clinical history of predisposing conditions, and medication history during COVID-19. RESULTS: All patients were either in recovery following COVID-19 or had ongoing infection. Most patients were diabetic with increased glycosylated haemoglobin, and most patients received steroids and antibiotics for COVID-19. Thirty sinonasal mucosal debridement specimens from various sites, nine orbital exenteration specimens and one frontal decompression craniectomy specimen were examined. Mucor spp. were observed in necrotic tissue, and the presence of vessel and nerve invasion was documented. There were four deaths. CONCLUSION: ROCM is a life-threatening disease. A high index of suspicion with prompt aggressive surgical and medical management by a multi-disciplinary team can be life saving. Efforts to maintain an optimal glycaemic index is likely to be helpful in preventing ROCM. Judicious use of steroids is mandatory to control the collateral epidemic of ROCM in India.