{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T02:04:23Z","timestamp":1784081063482,"version":"3.55.0"},"reference-count":21,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T00:00:00Z","timestamp":1783987200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JoF"],"abstract":"<jats:p>Rhino-orbital mucormycosis is a rare, life-threatening opportunistic fungal infection, typically affecting immunocompromised patients. During the COVID-19 pandemic, increased cases were mainly linked to SARS-CoV-2 infection, diabetes, and corticosteroid exposure. We report a severe case in a previously healthy 44-year-old immunocompetent man who developed acute left-sided exophthalmos, ophthalmoplegia, severe visual loss, and systemic deterioration 10 days after AZD1222 COVID-19 vaccination. Clinical and radiologic findings suggested invasive rhino-orbital fungal disease, prompting immediate liposomal amphotericin B, broad-spectrum antibiotics, urgent endoscopic sinus surgery, and repeated orbital\u2013sinonasal debridements with amphotericin B irrigation. Histopathological examination demonstrated broad aseptate hyphae with tissue necrosis, consistent with mucormycosis, while fungal culture and ITS sequencing identified Rhizopus arrhizus as the causative species. Therapy was later adjusted to include isavuconazole and antibacterial coverage for persistent inflammation and secondary colonization. Orbital and systemic improvement occurred within the first week, with globe preservation and marked proptosis reduction at 6 months, despite persistent ophthalmoplegia and residual light perception. Isavuconazole was continued for 2 years, with no recurrence during 3 years of follow-up. Although causality with vaccination cannot be established, the temporal association and biological plausibility warrant further investigation. Early suspicion and prompt combined medical\u2013surgical management are essential in rapidly progressive orbital cellulitis.<\/jats:p>","DOI":"10.3390\/jof12070516","type":"journal-article","created":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T01:05:58Z","timestamp":1784077558000},"page":"516","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Rhino-Orbital Mucormycosis Following COVID-19 Viral Vector Vaccination in an Immunocompetent Patient"],"prefix":"10.3390","volume":"12","author":[{"given":"Diego","family":"Strianese","sequence":"first","affiliation":[{"name":"Ophthalmology Unit, Department of Neurosciences, Reproductive Sciences and Dentistry, University of Naples Federico II, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3492-014X","authenticated-orcid":false,"given":"Mario","family":"Troisi","sequence":"additional","affiliation":[{"name":"Ophthalmology Unit, Department of Neurosciences, Reproductive Sciences and Dentistry, University of Naples Federico II, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8498-6991","authenticated-orcid":false,"given":"Adriana","family":"Iuliano","sequence":"additional","affiliation":[{"name":"Ophthalmology Unit, Department of Neurosciences, Reproductive Sciences and Dentistry, University of Naples Federico II, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dana","family":"Cohen","sequence":"additional","affiliation":[{"name":"Ophthalmology Unit, Galilee Medical Center, Nahariya 22100, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Matarazzo","sequence":"additional","affiliation":[{"name":"Ophthalmology Unit, Department of Neurosciences, Reproductive Sciences and Dentistry, University of Naples Federico II, 80131 Naples, Italy"},{"name":"Department of Physics \u201cEttore Pancini\u201d, University of Naples Federico II, 80126 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Paola","family":"Laezza","sequence":"additional","affiliation":[{"name":"Ophthalmology Unit, Ospedale del Mare, ASL Napoli 1-centro, 80147 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8685-5434","authenticated-orcid":false,"given":"Biagio","family":"Pinchera","sequence":"additional","affiliation":[{"name":"Infectious Diseases Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-0215-5624","authenticated-orcid":false,"given":"Maria Laura","family":"Passaro","sequence":"additional","affiliation":[{"name":"Ophthalmology Unit, Department of Neurosciences, Reproductive Sciences and Dentistry, University of Naples Federico II, 80131 Naples, Italy"},{"name":"Department of Medicine and Health Sciences \u201cV. Tiberio\u201d, University of Molise, 86100 Campobasso, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Davide","family":"Tramontano","sequence":"additional","affiliation":[{"name":"Ophthalmology Unit, Department of Neurosciences, Reproductive Sciences and Dentistry, University of Naples Federico II, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3231-1930","authenticated-orcid":false,"given":"Vittoria","family":"Lanni","sequence":"additional","affiliation":[{"name":"Ophthalmology Unit, Department of Neurosciences, Reproductive Sciences and Dentistry, University of Naples Federico II, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonella","family":"D\u2019Aponte","sequence":"additional","affiliation":[{"name":"Ophthalmology Unit, Department of Neurosciences, Reproductive Sciences and Dentistry, University of Naples Federico II, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5199-8451","authenticated-orcid":false,"given":"Ivan","family":"Gentile","sequence":"additional","affiliation":[{"name":"Infectious Diseases Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8477-6188","authenticated-orcid":false,"given":"Ciro","family":"Costagliola","sequence":"additional","affiliation":[{"name":"Ophthalmology Unit, Department of Neurosciences, Reproductive Sciences and Dentistry, University of Naples Federico II, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,14]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e405","DOI":"10.1016\/S1473-3099(19)30312-3","article-title":"Global guideline for the diagnosis and management of mucormycosis: An initiative of the European Confederation of Medical Mycology in cooperation with the Mycoses Study Group Education and Research Consortium","volume":"19","author":"Cornely","year":"2019","journal-title":"Lancet Infect. Dis."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"894","DOI":"10.1016\/j.clinthera.2018.03.009","article-title":"Recent advances in the pathogenesis of mucormycoses","volume":"40","author":"Petrikkos","year":"2018","journal-title":"Clin. Ther."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1670","DOI":"10.4103\/ijo.IJO_1565_21","article-title":"Epidemiology, clinical profile, management, and outcome of COVID-19-associated rhino-orbital-cerebral mucormycosis in 2826 patients in India\u2014Collaborative OPAI-IJO Study on Mucormycosis in COVID-19 (COSMIC), Report 1","volume":"69","author":"Sen","year":"2021","journal-title":"Indian J. Ophthalmol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"e543","DOI":"10.1016\/S2666-5247(21)00237-8","article-title":"The emergence of COVID-19-associated mucormycosis: A review of cases from 18 countries","volume":"3","author":"Hoenigl","year":"2022","journal-title":"Lancet Microbe"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1007\/s10792-020-01575-2","article-title":"Ocular tropism of coronavirus (CoVs): A comparison of the interaction between the animal-to-human transmitted coronaviruses (SARS-CoV-1, SARS-CoV-2, MERS-CoV, CoV-229E, NL63, OC43, HKU1) and the eye","volume":"41","author":"Strianese","year":"2021","journal-title":"Int. Ophthalmol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1080\/01676830.2020.1775264","article-title":"Oculoplastic management of patients in the COVID-19 era: Experience from an Italian tertiary referral center","volume":"39","author":"Lanni","year":"2020","journal-title":"Orbit"},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Troisi, M., Zannella, C., Troisi, S., De Bernardo, M., Galdiero, M., Franci, G., and Rosa, N. (2022). Ocular surface infection by SARS-CoV-2 in COVID-19 pneumonia patients admitted to sub-intensive unit: Preliminary results. Microorganisms, 10.","DOI":"10.3390\/microorganisms10020347"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Troisi, M., Troisi, S., Vitiello, L., Bellucci, C., and Costagliola, C. (2025). Ocular and neurological sequelae in long COVID: Dry eye, asthenopia, sleep disorders, asthenia, and restless legs syndrome\u2014A case report with literature review. Life, 15.","DOI":"10.3390\/life15081289"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1216","DOI":"10.1080\/09273948.2021.1976221","article-title":"Ocular adverse events after COVID-19 vaccination","volume":"29","author":"Ng","year":"2021","journal-title":"Ocul. Immunol. Inflamm."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1038\/s41577-021-00526-x","article-title":"COVID-19 vaccines: Modes of immune activation and future challenges","volume":"21","author":"Teijaro","year":"2021","journal-title":"Nat. Rev. Immunol."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Skiada, A., Pavleas, I., and Drogari-Apiranthitou, M. (2020). Epidemiology and diagnosis of mucormycosis: An update. J. Fungi, 6.","DOI":"10.3390\/jof6040265"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"693","DOI":"10.1111\/j.1469-0691.2009.02884.x","article-title":"Rhinocerebral mucormycosis in patients without predisposing medical conditions: A review of the literature","volume":"15","author":"Elinav","year":"2009","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Baldin, C., and Ibrahim, A.S. (2017). Molecular mechanisms of mucormycosis\u2014The bitter and the sweet. PLoS Pathog., 13.","DOI":"10.1371\/journal.ppat.1006408"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"S16","DOI":"10.1093\/cid\/cir865","article-title":"Pathogenesis of mucormycosis","volume":"54","author":"Ibrahim","year":"2012","journal-title":"Clin. Infect. Dis."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1172\/JCI71349","article-title":"CotH3 mediates fungal invasion of host cells during mucormycosis","volume":"124","author":"Gebremariam","year":"2014","journal-title":"J. Clin. Investig."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"John, T.M., Jacob, C.N., and Kontoyiannis, D.P. (2021). When uncontrolled diabetes mellitus and severe COVID-19 converge: The perfect storm for mucormycosis. J. Fungi, 7.","DOI":"10.3390\/jof7040298"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1038\/s41591-020-01179-4","article-title":"Phase 1\/2 trial of SARS-CoV-2 vaccine ChAdOx1 nCoV-19 with a booster dose induces multifunctional antibody responses","volume":"27","author":"Barrett","year":"2021","journal-title":"Nat. Med."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"2092","DOI":"10.1056\/NEJMoa2104840","article-title":"Thrombotic thrombocytopenia after ChAdOx1 nCov-19 vaccination","volume":"384","author":"Greinacher","year":"2021","journal-title":"N. Engl. J. Med."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Janjua, O.S., Shaikh, M.S., Fareed, M.A., Qureshi, S.M., Khan, M.I., Hashem, D., and Zafar, M.S. (2022). Dental and oral manifestations of COVID-19-related mucormycosis: Diagnoses, management strategies and outcomes. J. Fungi, 8.","DOI":"10.3390\/jof8010044"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"101360","DOI":"10.1016\/j.mycmed.2023.101360","article-title":"Decrypting the occurrence of mucormycosis following dental extractions: A systematic review","volume":"33","author":"Verma","year":"2023","journal-title":"J. Mycol. Med."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1016\/j.jdcr.2021.06.012","article-title":"Cutaneous mucormycosis following COVID-19 vaccination in a patient with bullous pemphigoid","volume":"15","author":"Shah","year":"2021","journal-title":"JAAD Case Rep."}],"container-title":["Journal of Fungi"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2309-608X\/12\/7\/516\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T01:28:39Z","timestamp":1784078919000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2309-608X\/12\/7\/516"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,14]]},"references-count":21,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2026,7]]}},"alternative-id":["jof12070516"],"URL":"https:\/\/doi.org\/10.3390\/jof12070516","relation":{},"ISSN":["2309-608X"],"issn-type":[{"value":"2309-608X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,14]]}}}