{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,13]],"date-time":"2026-03-13T03:02:31Z","timestamp":1773370951494,"version":"3.50.1"},"reference-count":42,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2021,7,27]],"date-time":"2021-07-27T00:00:00Z","timestamp":1627344000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100017261","name":"Universidad Nacional Autonoma de Honduras","doi-asserted-by":"publisher","award":["2-03-01-01"],"award-info":[{"award-number":["2-03-01-01"]}],"id":[{"id":"10.13039\/501100017261","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Vaccines"],"abstract":"<jats:p>Background: Mucormycosis is a life-threatening invasive fungal infection most commonly observed in immunocompromised patients. Throughout the COVID-19 pandemic, a growing number of Mucorales associated infections, now termed COVID-19 associated mucormycosis (CAM), have been reported. Despite an increase in fatality reports, no cases of rhino-orbital CAM complicated with gangrenous bone necrosis have been described in the literature to date. Case: A 56-year-old male with a recent COVID-19 diagnosis developed rhino-orbital mucormycosis after 22 days of treatment with dexamethasone. Cultures and histopathological assessment of tissue biopsy confirmed the diagnosis. The patient survived after treatment with amphotericin B. Conclusions: Mucormycosis is an invasive fungal infection affecting mostly immunocompromised patients. Along with the COVID-19 pandemic, the inappropriate use of steroids, in addition to concurrent risk factors, such as diabetes, has led to an increase in the occurrence of these devastating mycoses, leading to the development of severe presentations and complications, as observed in many cases. Early diagnosis and prompt treatment are crucial in order to avoid dissemination and fatal outcomes.<\/jats:p>","DOI":"10.3390\/vaccines9080826","type":"journal-article","created":{"date-parts":[[2021,7,27]],"date-time":"2021-07-27T22:35:02Z","timestamp":1627425302000},"page":"826","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":19,"title":["COVID-19 Associated Rhino-Orbital Mucormycosis Complicated by Gangrenous and Bone Necrosis\u2014A Case Report from Honduras"],"prefix":"10.3390","volume":"9","author":[{"given":"Elsa Yolanda","family":"Palou","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Faculty of Medical Sciences, Universidad Nacional Aut\u00f3noma de Honduras, Tegucigalpa 11101, Honduras"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mar\u00eda Auxiliadora","family":"Ramos","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Hospital Escuela, Tegucigalpa 11101, Honduras"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emec","family":"Cherenfant","sequence":"additional","affiliation":[{"name":"Universidad Nacional Aut\u00f3noma de Honduras, Tegucigalpa 11101, Honduras"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adoni","family":"Duarte","sequence":"additional","affiliation":[{"name":"Department of Morphological Sciences, Faculty of Medical Sciences, Universidad Nacional Aut\u00f3noma de Honduras, Tegucigalpa 11101, Honduras"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Itzel Carolina","family":"Fuentes-Barahona","sequence":"additional","affiliation":[{"name":"Faculty of Medical Sciences, Universidad Nacional Aut\u00f3noma de Honduras, Tegucigalpa 11101, Honduras"},{"name":"Department of Gynecology and Obstetrics, Hospital Escuela, Tegucigalpa 11101, Honduras"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9002-5807","authenticated-orcid":false,"given":"Lysien I.","family":"Zambrano","sequence":"additional","affiliation":[{"name":"Unit of Scientific Research (UIC), Faculty of Medical Sciences, Universidad Nacional Aut\u00f3noma de Honduras, Tegucigalpa 11101, Honduras"},{"name":"Latin American Network of Coronavirus Disease 2019 Research (LANCOVID), Pereira, Risaralda 660003, Colombia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1221-0518","authenticated-orcid":false,"given":"Fausto","family":"Mu\u00f1oz-Lara","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Faculty of Medical Sciences, Universidad Nacional Aut\u00f3noma de Honduras, Tegucigalpa 11101, Honduras"},{"name":"Department of Internal Medicine, Hospital Escuela, Tegucigalpa 11101, Honduras"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sandra Aracely","family":"Montoya-Ramirez","sequence":"additional","affiliation":[{"name":"Department of Mycology, Hospital Escuela, Tegucigalpa 11101, Honduras"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alex Francisco","family":"Cardona-Ortiz","sequence":"additional","affiliation":[{"name":"Post-Graduate Internal Medicine, Faculty of Medical Sciences, Universidad Nacional Aut\u00f3noma de Honduras, Tegucigalpa 11101, Honduras"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jorge Alberto","family":"Valle-Reconco","sequence":"additional","affiliation":[{"name":"Deanship, Facultad de Ciencias M\u00e9dicas, Universidad Nacional Aut\u00f3noma de Honduras, Tegucigalpa 11101, Honduras"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Juan J.","family":"Montenegro-Idrogo","sequence":"additional","affiliation":[{"name":"Latin American Network of Coronavirus Disease 2019 Research (LANCOVID), Pereira, Risaralda 660003, Colombia"},{"name":"Faculty of Health Sciences, Universidad Cientifica del Sur, Lima 15046, Peru"},{"name":"Infectious and Tropical Diseases Service, Hospital Nacional Dos de Mayo, Lima 15072, Peru"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"D. Katterine","family":"Bonilla-Aldana","sequence":"additional","affiliation":[{"name":"Latin American Network of Coronavirus Disease 2019 Research (LANCOVID), Pereira, Risaralda 660003, Colombia"},{"name":"Semillero de Investigaci\u00f3n en Zoonosis (SIZOO), Grupo de Investigaci\u00f3n GISCA, Fundaci\u00f3n Universitaria Aut\u00f3noma de las Am\u00e9ricas, Sede Pereira, Pereira 660003, Colombia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1259-1736","authenticated-orcid":false,"given":"Alberto E.","family":"Paniz-Mondolfi","sequence":"additional","affiliation":[{"name":"Latin American Network of Coronavirus Disease 2019 Research (LANCOVID), Pereira, Risaralda 660003, Colombia"},{"name":"Laboratory of Microbiology, Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029-6574, USA"},{"name":"Instituto de Investigaciones Biom\u00e9dicas IDB\/Incubadora Venezolana de la Ciencia, Barquisimeto 3001, Venezuela"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alfonso J.","family":"Rodriguez-Morales","sequence":"additional","affiliation":[{"name":"Latin American Network of Coronavirus Disease 2019 Research (LANCOVID), Pereira, Risaralda 660003, Colombia"},{"name":"Grupo de Investigaci\u00f3n Biomedicina, Faculty of Medicine, Fundaci\u00f3n Universitaria Aut\u00f3noma de las Americas, Pereira, Risaralda 660003, Colombia"},{"name":"Master of Clinical Epidemiology and Biostatistics, Universidad Cientifica del Sur, Lima 15046, Peru"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2021,7,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"556","DOI":"10.1128\/CMR.18.3.556-569.2005","article-title":"Novel perspectives on mucormycosis: Pathophysiology, presentation, and management","volume":"18","author":"Spellberg","year":"2005","journal-title":"Clin. Microbiol. Rev."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"He, J., Sheng, G., Yue, H., Zhang, F., and Zhang, H.L. (2021). Isolated pulmonary mucormycosis in an immunocompetent patient: A case report and systematic review of the literature. BMC Pulm. Med., 21.","DOI":"10.1186\/s12890-021-01504-8"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"e2020233","DOI":"10.4322\/acr.2020.233","article-title":"Isolated cerebral mucormycosis masquerading as a tumor in an immunocompetent patient","volume":"11","author":"Chandra","year":"2021","journal-title":"Autops. Case Rep."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"S23","DOI":"10.1093\/cid\/cir866","article-title":"Epidemiology and clinical manifestations of mucormycosis","volume":"54","author":"Petrikkos","year":"2012","journal-title":"Clin. Infect. Dis."},{"key":"ref_5","first-page":"708","article-title":"Mucormycosis in a patient with AIDS receiving systemic steroids","volume":"113","author":"Pan","year":"2013","journal-title":"J. Am. Osteopath. Assoc."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Bhatt, H., Zilani, G., and Hayhurst, C. (2018). Orbitocerebral mucormycosis and intracranial haemorrhage: A role for caution with steroids in suspected giant cell arteritis. BMJ Case Rep., 2018.","DOI":"10.1136\/bcr-2017-224086"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"441","DOI":"10.1111\/j.1365-2141.2004.05080.x","article-title":"Cerebral mucormycosis in a patient with myelodysplastic syndrome taking corticosteroids","volume":"126","author":"Droll","year":"2004","journal-title":"Br. J. Haematol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1016\/j.mmcr.2020.05.008","article-title":"A case of invasive pulmonary mucormycosis resulting from short courses of corticosteroids in a well-controlled diabetic patient","volume":"29","author":"Hoang","year":"2020","journal-title":"Med. Mycol. Case Rep."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1007\/s13365-019-00804-4","article-title":"Concomitant cerebral aspergillosis and mucormycosis in an immunocompetent woman treated with corticosteroids","volume":"26","author":"Mantero","year":"2020","journal-title":"J. Neurovirol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"693","DOI":"10.1056\/NEJMoa2021436","article-title":"Dexamethasone in Hospitalized Patients with COVID-19","volume":"384","author":"Horby","year":"2021","journal-title":"N. Engl. J. Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1186\/s12941-020-00358-y","article-title":"Successful recovery of COVID-19 pneumonia in a patient from Colombia after receiving chloroquine and clarithromycin","volume":"19","author":"Millan","year":"2020","journal-title":"Ann. Clin. Microbiol. Antimicrob."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"287","DOI":"10.7326\/M20-2496","article-title":"Hydroxychloroquine or Chloroquine for Treatment or Prophylaxis of COVID-19: A Living Systematic Review","volume":"173","author":"Hernandez","year":"2020","journal-title":"Ann. Intern. Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"n526","DOI":"10.1136\/bmj.n526","article-title":"A living WHO guideline on drugs to prevent COVID-19","volume":"372","author":"Lamontagne","year":"2021","journal-title":"BMJ"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"m2980","DOI":"10.1136\/bmj.m2980","article-title":"Drug treatments for COVID-19: Living systematic review and network meta-analysis","volume":"370","author":"Siemieniuk","year":"2020","journal-title":"BMJ"},{"key":"ref_15","first-page":"20499361211027065","article-title":"COVID-19 associated mucormycosis: The urgent need to reconsider the indiscriminate use of immunosuppressive drugs","volume":"8","author":"Sah","year":"2021","journal-title":"Ther. Adv. Infect. Dis."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"746","DOI":"10.5946\/ce.2020.180","article-title":"Rare and Fatal Gastrointestinal Mucormycosis (Zygomycosis) in a COVID-19 Patient: A Case Report","volume":"53","author":"Santos","year":"2020","journal-title":"Clin. Endosc."},{"key":"ref_17","first-page":"e13163","article-title":"A Case of Fatal Rhino-Orbital Mucormycosis Associated With New Onset Diabetic Ketoacidosis and COVID-19","volume":"13","year":"2021","journal-title":"Cureus"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Kanwar, A., Jordan, A., Olewiler, S., Wehberg, K., Cortes, M., and Jackson, B.R. (2021). A Fatal Case of Rhizopus azygosporus Pneumonia Following COVID-19. J. Fungi, 7.","DOI":"10.3390\/jof7030174"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"e245","DOI":"10.1016\/S2666-5247(20)30115-4","article-title":"Histopathological findings and viral tropism in UK patients with severe fatal COVID-19: A post-mortem study","volume":"1","author":"Hanley","year":"2020","journal-title":"Lancet Microbe"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"101623","DOI":"10.1016\/j.tmaid.2020.101623","article-title":"Clinical, laboratory and imaging features of COVID-19: A systematic review and meta-analysis","volume":"34","year":"2020","journal-title":"Travel Med. Infect. Dis."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"e126","DOI":"10.15190\/d.2021.5","article-title":"High mortality co-infections of COVID-19 patients: Mucormycosis and other fungal infections","volume":"9","author":"Bhatt","year":"2021","journal-title":"Discoveries"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1194","DOI":"10.1093\/ndt\/9.8.1194","article-title":"Mucormycosis in transplant recipients: Possible case-case transmission and potentiation by cytomegalovirus","volume":"9","author":"Andrews","year":"1994","journal-title":"Nephrol. Dial. Transplant."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1035","DOI":"10.2214\/ajr.159.5.1414771","article-title":"Mucormycosis osteomyelitis causing avascular necrosis of the cuboid bone: MR imaging findings","volume":"159","author":"Chaudhuri","year":"1992","journal-title":"AJR Am. J. Roentgenol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1016\/S0278-2391(98)90883-7","article-title":"Oral and rhinoorbital mucormycosis: Case report","volume":"56","author":"Damante","year":"1998","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"532","DOI":"10.1016\/j.bjoms.2005.05.012","article-title":"Extensive maxillary sequestration resulting from mucormycosis","volume":"43","author":"Huang","year":"2005","journal-title":"Br. J. Oral Maxillofac. Surg."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Park, Y.L., Cho, S., and Kim, J.W. (2021). Mucormycosis originated total maxillary and cranial base osteonecrosis: A possible misdiagnosis to malignancy. BMC Oral Health, 21.","DOI":"10.1186\/s12903-021-01411-8"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"737","DOI":"10.1288\/00005537-198005000-00002","article-title":"Hyperbaric oxygen in the treatment of rhinocerebral mucormycosis","volume":"90 Pt 1","author":"Price","year":"1980","journal-title":"Laryngoscope"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"411","DOI":"10.1046\/j.1525-1470.2003.20508.x","article-title":"Gangrenous cutaneous mucormycosis in a child with a solid organ transplant: A case report and review of the literature","volume":"20","author":"Boyd","year":"2003","journal-title":"Pediatr. Dermatol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"618","DOI":"10.4103\/IJPM.IJPM_854_15","article-title":"Invasive, gangrenous mucormycosis of arm: A fatal opportunistic infection in a highly immunocompromised host","volume":"62","author":"Kanagaraju","year":"2019","journal-title":"Indian J. Pathol. Microbiol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1097\/PEC.0b013e318163dbf7","article-title":"Primary gangrenous cutaneous mucormycosis of the scalp in a child: A case report","volume":"24","author":"Koklu","year":"2008","journal-title":"Pediatr. Emerg. Care"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1007\/s11046-013-9654-z","article-title":"Gangrenous cutaneous mucormycosis caused by Rhizopus oryzae: A case report and review of primary cutaneous mucormycosis in China over Past 20 years","volume":"176","author":"Li","year":"2013","journal-title":"Mycopathologia"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"912","DOI":"10.1016\/S0194-59980300463-7","article-title":"Gangrenous primary cutaneous mucormycosis of the scalp in an iatrogenically immunosuppressed trauma patient","volume":"128","author":"Lucas","year":"2003","journal-title":"Otolaryngol. Head Neck Surg."},{"key":"ref_33","first-page":"453","article-title":"Hospital-acquired gangrenous mucormycosis","volume":"59","author":"Patterson","year":"1986","journal-title":"Yale J. Biol. Med."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1097\/00006454-198203000-00009","article-title":"Primary cutaneous mucormycosis: Superficial and gangrenous infections","volume":"1","author":"Ryan","year":"1982","journal-title":"Pediatr. Infect. Dis."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"548","DOI":"10.1093\/tropej\/fmx094","article-title":"Gangrenous Necrotizing Cutaneous Mucormycosis in an Immunocompetent Neonate: A Case Report from Oman","volume":"64","author":"Sawardekar","year":"2018","journal-title":"J. Trop. Pediatr."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"100771","DOI":"10.1016\/j.ajoc.2020.100771","article-title":"Rhino-orbital-cerebral mucormycosis (ROCM) and associated cerebritis treated with adjuvant retrobulbar amphotericin B","volume":"19","author":"Safi","year":"2020","journal-title":"Am. J. Ophthalmol. Case Rep."},{"key":"ref_37","first-page":"4215989","article-title":"Rhino-Orbito-Cerebral Mucormycosis: Two Cases with Amaurosis as Presentation, Medical Surgical Management and Follow-Up","volume":"2019","year":"2019","journal-title":"Case Rep. Ophthalmol. Med."},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Patel, A., Agarwal, R., Rudramurthy, S.M., Shevkani, M., Xess, I., Sharma, R., Savio, J., Sethuraman, N., Madan, S., and Shastri, P. (2021). Multicenter Epidemiologic Study of Coronavirus Disease-Associated Mucormycosis, India. Emerg. Infect. Dis., 27.","DOI":"10.3201\/eid2709.210934"},{"key":"ref_39","unstructured":"(2021, June 11). PAHO Epidemiological Alert: COVID-19 Associated Mucormycosis. Available online: https:\/\/www.paho.org\/en\/documents\/epidemiological-alert-COVID-19-associated-mucormycosis."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1","DOI":"10.22354\/in.v24i3.851","article-title":"Consenso colombiano de atenci\u00f3n, diagn\u00f3stico y manejo de la infecci\u00f3n por SARS-CoV-2\/COVID-19 en establecimientos de atenci\u00f3n de la salud\u2014Recomendaciones basadas en consenso de expertos e informadas en la evidencia","volume":"24","year":"2020","journal-title":"Infectio"},{"key":"ref_41","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_42","doi-asserted-by":"crossref","unstructured":"Stone, N., Gupta, N., and Schwartz, I. (2021). Mucormycosis: Time to address this deadly fungal infection. Lancet Microbe.","DOI":"10.1016\/S2666-5247(21)00148-8"}],"container-title":["Vaccines"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-393X\/9\/8\/826\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T06:35:40Z","timestamp":1760164540000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-393X\/9\/8\/826"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,7,27]]},"references-count":42,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2021,8]]}},"alternative-id":["vaccines9080826"],"URL":"https:\/\/doi.org\/10.3390\/vaccines9080826","relation":{},"ISSN":["2076-393X"],"issn-type":[{"value":"2076-393X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,7,27]]}}}