Alternating pattern of rhino-orbital-cerebral mucormycosis with COVID-19 in diabetic patients

Eur Arch Otorhinolaryngol. 2023 Jan;280(1):219-226. doi: 10.1007/s00405-022-07526-0. Epub 2022 Jun 29.


Purpose: Our aim was to analyze the patients with diabetic rhino-orbital-cerebral mucormycosis that we have treated in our clinic in the last 5 years, and to reveal the altering conditions with COVID-19.

Materials and methods: A retrospective study was conducted on 39 rhino-orbital-cerebral mucormycosis (ROCM) patients with diabetes mellitus between 2017 and 2022. The patients were divided into two groups as those associated with and not associated with COVID-19 and compared.

Results: Thirty-nine diabetic patients were included in the study, with 15 (38.5%) of them being COVID-19 associated mucormycosis (CAM) group. CAM patients showed higher orbital involvement and cavernous sinus involvement (p = 0.002 and p = 0.013, respectively). The mortality rate in the non-COVID-19 associated mucormycosis (non-CAM) group was statistically higher in patients with intracranial and cavernous sinus involvement (p = 0.015 and p = 0.033, respectively). The difference between the overall survival of the CAM patients and non-CAM patients was not statistically significant (p = 0.741).

Conclusions: With COVID-19, progressive mucormycosis accompanied by orbital and intracranial involvement is observed more frequently. However, on the contrary, the mortality rate in COVID-19-associated mucormycosis is considerably lower than expected. The fact that temporary immune suppression can be ameliorated with adequate supportive treatment and liposomal amphotericin-B which can be given to patients in high doses may explain this situation. It has been attained hints that the essential factor in the treatment of COVID-19-associated ROCM is the control of the underlying disease and to be cautious in the decision of early aggressive surgery.

Keywords: COVID-19 pandemic; COVID-19-associated mucormycosis; Orbital exenteration; Rhino-orbital–cerebral mucormycosis.

MeSH terms

  • Antifungal Agents / therapeutic use
  • COVID-19* / complications
  • Diabetes Mellitus* / epidemiology
  • Eye Diseases*
  • Humans
  • Mucormycosis* / drug therapy
  • Mucormycosis* / therapy
  • Orbital Diseases* / etiology
  • Orbital Diseases* / therapy
  • Retrospective Studies


  • Antifungal Agents