PMC9393194_01
The clinical course of COVID-19-associated mucormycosis: (a) cutaneous manifestation of bilateral periorbital mucormycosis. The small area of skin necrosis on bilateral sides; (b) the necrotic epidermal lesion with ill-defined raised margins and a necrotic base significantly worsened and expanded from the medial canthi, eyelids, and periorbital area; (c) progressive cutaneous necrosis associated with the midfacial defect; (d) repaired cutaneous lesions after medical and surgical treatment.
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On examination, mild facial edema, periorbital edema, and facial paresthesia were apparent (Figure 1(a)). The patient's cutaneous lesions deteriorated on the second day of his admission in terms of the disease's rapid progression (Figure 1(b)). Following substantial midfacial bone erosion and skin necrosis, the second surgery was performed (Figure 1(c)). The skin in the midface area had a considerable defect, which was reconstructed using advancement flaps following maximal debridement of the bone and skin (Figure 1(d)).
Radiologic characteristics of COVID-19-associated mucormycosis: (a) axial bone window CT scan demonstrated partial opacification of bilateral maxillary and sphenoid sinuses. (b) Axial postcontrast T1 weighted image revealed smooth ring enhancement in bilateral frontal lobes mass; (c) axial fluid-attenuated inversion recovery MRI showed a hyperintense mass containing air bubbles with perilesional vasogenic edema in bilateral frontal lobes; (d) drainage of the yellow brain abscess material using craniotomy.
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As a result of a mass lesion in the frontal lobe, he underwent craniotomy (Figure 2).
PMC9393194_02
Mycology confirmation and detection of fungal elements by phenotypic methods: (a) grayish brown colony of Rhizopus spp. on Sabouraud dextrose agar with chloramphenicol; (b) direct microscopy with potassium hydroxide 10% (KOH 10%) shows broad and aseptate hyphae of Rhizopus spp. in necrotic tissue (black arrows), x40; (c) reproductive structures of Rhizopus spp. sporangium (black arrow), sporangiophore (blue arrow), and sporangiospores (green arrow), x40.
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Biopsy reports from the affected sinuses were in agreement with this conclusion (Figure 3).