Acute bilateral blindness in a young Covid-19 patient with rhino-orbito-cerebral mucormycosis

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Case reportA diabetic 20-year-old male patient, not previously vaccinated against SARS-CoV-2, was referred to our emergency department for rapid bilateral visual loss with left periorbital pain, proptosis, palpebral edema and swelling.He had been admitted one week before in a primary Covid-19 center for COVID-19 respiratory distress syndrome and treated with corticosteroids.Upon ophthalmic examination, both eyes had a fixed dilated pupil with no light perception.The left eye showed features of orbital cellulitis (Fig. 1) with complete ophthalmoplegia (Fig. 2).There was a mild proptosis and limited abduction in the right eye (Fig. 2), and fundus examination showed retinal whitening with a cherry red spot and segmental blood flow consistent with central retinal artery occlusion (CRAO) (Fig. 3).Swept source OCT showed in the right eye hyperreflectivity of inner retinal layers corresponding to ischemic edema (Fig. 3).Brain CT complemented with cerebral MRI disclosed endocranial extension of the disease and thrombosis of both left cavernous sinus and left internal carotid artery (Fig. 1).The patient underwent emergency endoscopic sinus examination and removal of a blackish necrotic tissues from paranasal sinuses.Histopathological examination confirmed the diagnosis of mucormycosis.

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