Septal Necrosis as Primary Presentation for Mucormycosis in Covid-19 Era

Abstract

Objectives: To report unusual presentation of sinonasal mucormycosis, To emphasize on importance of MRI sequences in dealing with mucormycosis cases. Patients and Methods: We reported a case with persistent rhinological symptoms after Covid-19 recovery, presented endoscopically with necrotic eschar/crust on nasal septum with apparently normal lateral nasal mucosa. MRI T2 fat suppression revealed inflammatory process within RT pterygopalatine / infratemporal fossa territory. Endoscopic sinus surgery was done for debridement of necrotic septal nasal mucosa, exploration of RT PPF / ITF shows pus emerging from it with necrosis of posterior feeding vessel of the nose "SPA". Nasal septum is characterized by double vascularity from both side , but sudden interruption from one side could not be compensated from healthy side leading to necrosis. Conclusion: Any persistent rhinological symptoms after covid-19 infection with necrotic eschar anywhere within rhinoorbital territory should be considered as mucormycosis till prove otherwise.

Degree of Orbital Affections in Cases of Nasal Mucormycosis Associated with COVID-19

“…Additionally, middle turbinate necrosis, which is regarded as the hallmark indication of sinonasal mucormycosis in nasal endoscopy, was seen in all instances. When present in patients with known or suspected fungal sinus infections, this result should alert doctors to the possibility of diagnosing fulminant fungal rhinosinusitis (28) .…”