Purpose: To report two cases of COVID-19 under treatment with a corticosteroid; in one case rhino-orbitocerebral mucormycosis and in another one rhino-orbital mucormycosis developed. Case presentation: A 40-year old woman and a 54-year old man with severe COVID-19 underwent corticosteroid therapy for immune-related lung injuries. The first case presented with a bilateral visual loss and complete ophthalmoplegia of the right eye. The second case presented with vision loss, proptosis, orbital inflammation, and complete ophthalmoplegia on the left side. Histopathologic, nasal endoscopic examinations, and radiologic findings confirmed mucormycosis in both patients. The patients denied orbital exenteration and were managed with systemic amphotericin B and daily endoscopic sinus debridement and irrigation with diluted amphotericin B. Because of the intracranial space involvement, the first case died. The second case was successfully managed surgically and medically. Conclusion: Rhino-orbital/cerebral mucormycosis may be developed in COVID-19 patients under treatment with corticosteroid, and requires prompt diagnosis and management.

rate. Besides, the high dose use of TXA was significantly associated with an increase in seizure attacks. Likely, it was speculated that low-dose TXA as 10 mg/kg bolus injection followed by 1 mg/kg/h continuous infusion could achieve a large proportion of TXA efficacy. 7 In our study, compared to the previously reported literature, although there was a slight improvement in blood loss in TXA administered groups compared to the control group, no significant difference was observed regarding this parameter between the study groups. We may postulate that since the nasal cavity is small and the blood vessels are abundant, our results could be due to meticulous hemostatic control during the surgeries. Our results are similar to previous studies, which reported that postulated the use of TXA decreases postoperative blood loss. 12,13 It was reported that an IV dose of 10 mg/kg TXA produces a therapeutic blood concentration for 3 hours, while 20 mg/kg maintains the same effect for eighth hours. This shows that irrespective of the treatment, TXA acts mainly on fibrinolysis and not on primary coagulation. 13 A more extended infusion period may provide constant blood levels of TXA and reduce blood loss.Adverse effects of the systemic use of TXA are nausea, vomiting, deep vein thrombosis, pulmonary embolism, myocardial infarction, seizures, visual disturbances, and acute renal necrosis. 14 Our study observed no side effects since these unintended effects could be found in higher doses.The strength of our study was that the same surgeon performed all operations, and it was designed as a prospective randomized controlled study. However, our results might not be compatible with the previous studies due to the small sample size. Besides, we did not evaluate the most common surgery-related complications, such as eyelid edema and periorbital ecchymosis. A surgeon assessment score for the cleanness or visibility of the operation field also could be utilized. Further studies can be designed in rhinoplasty patients, taking into account our limitations or using an infusion of TXA instead of slow injection.In conclusion, the administration of single-dose IV and intermittent IV doses of TXA can decrease TBL and the number of blood transfusions required without complication in rhinoplasty surgery. But the statistical analysis and clinical relevance are not significant. TXA is a viable method of decreasing perioperative blood loss in rhinoplasty surgery with no complication. Further studies are required to find the ideal dosage and timing in ENT surgery.