Post Covid mucormycosis-possible avascular necrosis in facial angiosomal units as Etiopathogenesis

Abstract

SARS- CoV-2 has had a rampage of effects in the human body with the dysregulated innate immune response, ciliary dysfunction, cytokine storm, thrombo-inflammation, microvascular coagulation and eventual immune exhaustion. This cascade of events facilitates secondary bacterial and fungal infections especially in critically ill patients with mucormycosis as recently emerged as a life threatening complication of COVID-19 in our country. We propose a newer treatment consideration with regard to the etiopathogenesis of disease explained and regarding prevention and management of mucormycosis in covid-19 patients, considering the effect of hypercoagulability state, release of high levels of infectious and inflammatory mediators after cytokine storm, and its association with incidence of thromboembolism in vessels of face leading to increased occurrence of mucormycosis.

Authors proposed that cytokine storm is actually a Serotonin storm, which is based on experience of resolution of cases after using drug- Cyproheptadine, in severe cases of Covid-19, drug under investigation and clinical trial¹ for same.