A parallel epidemic of sino-nasal mucormycosis post-COVID pneumonia, and its anesthetic implications: a case report

There has been a rise in cases of sino-nasal mucormycosis in patients who contracted the COVID-19 virus and were on steroids. Population at risk includes diabetics and on immunosuppressant therapy and/or immunocompromised state. Perioperative management becomes challenging due to residual pulmonary disease secondary to COVID pneumonia and complication following systemic antifungal therapy. Such patients often have other associated illnesses like hypertension, obesity, and deranged renal functions, either as a part of metabolic syndrome or post-systemic antifungal therapy. We report a case of a 64-year-old female, a poorly controlled hypertensive, with class 1 obesity, and diabetic on oral hypoglycemic agents, hypothyroid on oral medications, and post-COVID pneumonia with recently diagnosed sino-nasal mucormycosis who was posted for debridement of the sino-nasal fungal mass. The gamut of co-morbid conditions along with post-COVID pneumonia status presents an anesthetic challenge apropos the optimization of the clinical conditions and timing of the surgery considering the emergent nature of the surgery. The timing of operative intervention for such patients is imperative and the treating team of anesthesiologist and the otorhinolaryngologist should aim to strike a balance between timely intervention to negate the spread of the infection to the orbit and brain causing potential irreparable damage and optimizing the cardio-respiratory and renal functions.