Presentation
Patient is COVID-19 positive with facial swelling and redness of right eye. Patient have diabetes mellitus on treatment.
Patient Data
Mixed signal intensity / predominant T2 hyperintense lobular collection seen in right maxillary & ethmoid and in sphenoid sinuses. There is mucosal enhancement in sinuses.
T2 hyperintensities also seen in right mastoid air cells – mastoiditis.
There is suggestion of mild proptosis of right eyeball. There is subtle increased T2 signal in orbital apex on right. Right superior ethmoid vein is prominent. Right medial rectus & inferior rectus muscles are bulky as compared to left with T2 hyperintensity and reveal enhancement after contrast administration.
There is soft tissue thickening in right lateral wall of nasopharynx with effaced parapharyngeal fat plane and enhancement after contrast administration. The right pterygoid, masseter and temporalis muscles are mildly bulky as compared to left with T2 hyperintensities and enhancement after contrast administration.
There is pachymeningeal enhancement.
Case Discussion
Mucormycosis is a opportunistic fungal infection which is seen in uncontrolled diabetes mellitus, immunocompromised status, systemic use of corticosteroids, pre-existing respiratory pathology, cancer, and stem cell transplant. Mucormycosis causes aggressive necrosis and infarction of the involved tissues hence early imaging plays a key role in early diagnosis to reduces the mortality and morbidity associated mucormycosis.
Sino-nasal endoscopy reveals fungal colonization.
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