Invasive Fungal Sinusitis in Patients With Coronavirus Disease 2019 Seen in South India

Abstract

Background:Coronavirus disease 2019 (COVID-19) has a vast array of presentations and associations with neuro-ophthalmic diseases. There has been a recent surge in ophthalmic manifestations secondary to fungal sinus infections in India especially in diabetic patients who were given systemic steroids. We present our COVID-19–related cranial neuropathies presenting in our clinic.Methods:This is a retrospective case series of 10 patients affected with COVID-19 disease and who presented with cranial nerve palsies at the neuro-ophthalmic department of a tertiary eye care hospital in South India. An analysis of electronic medical records data was performed, including their comorbidities, symptoms, cranial nerves involved, ocular and neuroimaging findings, site of lesion, etiology, and prognosis.Results:Most of the patients (7 of 10) presented with multiple cranial nerve palsies (MCNP) with poor visual acuity. 2 of the 10 cases succumbed to death due to the intracranial involvement. All MCNP cases had uncontrolled diabetes with a history of systemic steroids, and neuroimaging of these cases showed sinusitis of varying severity most of which were suggestive of fungal invasive type.Conclusion:Our study emphasizes the need to screen for fungal involvement in COVID-19 cases presenting with MCNP especially on diabetic patients on systemic steroids so that an early diagnosis may reduce visual loss and mortality. Physicians treating COVID-19 cases need to be aware of this dreadful complication.

Invasive Fungal Sinusitis in Patients With Coronavirus

“…As discussed in the article by Hema et al (1), perhaps the neurotrophic and neuroinvasive qualities of COVID primed the sinus mucosa for fungal invasion into the central nervous system. Our case further emphasizes the need to urgently screen for fungal involvement in patients with COVID presenting with multiple cranial nerve palsies.…”

“…W e enjoyed reading the recent article regarding invasive fungal sinusitis in patients with COVID-19 presenting with multiple cranial nerve palsies (1). At the same time as that report was published, we evaluated a 58-year-old insulin-dependent diabetic woman who was transferred to our medical center late one evening for visual loss and ophthalmoplegia in her left eye.…”