Introduction With the severe COVID-19 disease, opportunistic infection of Rhino-orbito-cerebral mucormycosis(ROCM) is increasing in India. Aim To study the laboratory parameters, histopathological features of sinus mucosal biopsies and exenterated orbits and clinical aspects of patients with ROCM. Materials and methods We retrospectively analysed nasal and sinus debridement biopsies and orbital exenteration specimen of 30 patients, along with their laboratory parameters, clinical history of predisposing conditions and medication history during COVID-19 infection. Results All patients were either in post COVID-19 recovery period or having ongoing COVID-19 infection. Most patients were diabetic with increased glycosylated hemoglobin (HbA1c). Steroids and antibiotics were used in most patients. 30 sinonasal mucosal debridement from various sites along with 9 orbital exenterations and one frontal decompression craniectomy specimen were examined. Mucor was densely seen in necrotic tissue and presence of vessel and nerve invasion was documented. There were four mortality. Conclusion ROCM is a life-threatening disease. High index of suspicion with prompt aggressive surgical and medical management by multi-disciplinary team can be life saving. Efforts to maintain optimal glycemic index is likely to be helpful in preventing ROCM. Judicious use of steroids is mandatory to control the collateral epidemic of ROCM in India.
Rhino-orbito-cerebral mucormycosis: An epidemic in a pandemic