Post-COVID-19 complications – pansinusitis with orbital and cerebral abscess. Case report

Abstract

The occurrence of superinfections in COVID-19 patients has attracted increasing attention in recent studies. They are associated with the immunocompromised state of the patient. Such a secondary infection is also fungal sinusitis. The most common causative agents are Zygomycetes (Rhizopus, Mucor, Rhizomucor) and Aspergillus, with mucormycosis being more commonly reported. Undetected for a longer period of time give orbital and brain complications, which are distinguished by high mortality. Treatment of this pathology is extremely difficult, but there are also described cases in which it is successful. Such is our clinical case. It concerns a 77-year-old patient who entered the ENT department of "MHAT – Shumen" SA with clinical manifestation of pansinusitis, complicated with brain and orbital abscess after suffering from COVID-19. It comes with severe headache, difficulty breathing, more to the left, pain and loss of vision of the left eye, inability to move the eyeball, ptosis of the left upper eyelid, infiltrate and hyperemia in the area of an inner eye corner spreading to the nose with two fistula openings, from which a thick purulent discharge leaks when pressed over the eyeball. CT showed pansinusitis complicated with a cerebral abscess in the left frontal lobe and an intraorbital abscess in the left medial. Along with antibiotic and antimycotic treatment (Ampicillin, Ceftriaxon, Teicoplanin, Fluconazole, Itraconazole), endonasal surgical treatment with sinus-nasal optics and external incision periorbital medial was carried out. Isolated and identified in NRL by mycoses are Aspergillus niger – en masse and Candida palmioleophila – moderately. A month after surgery, a new external incision periorbital was required. A smooth postoperative period followed. As a way out of the disease, pansinusitis, brain and orbital abscess were controlled, improved in the movements of the eyeball, with persistent ptosis of the left upper eyelid and lack of vision in the left eye.