Impact of Sinus Involvement Severity on Clinical Outcomes in COVID-19-Associated Rhino-Orbital Mucormycosis: A Cross-Sectional Study

The COVID-19 pandemic has precipitated a surge in invasive fungal infections, particularly rhino-orbital mucormycosis (ROM), with high mortality rates. This study investigates the association between the extent of sinus involvement at initial presentation and clinical outcomes in COVID-19-associated ROM. A cross-sectional study was conducted at a tertiary hospital in Iran from March 2021 to February 2022, including 20 patients with confirmed COVID-19 and ROM. Sinus involvement was assessed using the Lund-Mackay scoring system on CT scans. Clinical data, including comorbidities, corticosteroid use, and treatment outcomes, were analyzed. The cohort had a mean age of 56.05 ± 12.16 years, with a male predominance (60%). Diabetes mellitus was present in 60% of patients, and 95% had received corticosteroids. Mortality was 40%, with higher Lund-Mackay scores (8–9) significantly correlating with fatal outcomes (p < 0.05). Ocular involvement was observed in 62.5% of deceased patients. Patients with limited sinus involvement (scores ≤6) had better survival rates, while extensive disease (scores ≥8) was associated with poorer prognosis. The severity of sinus involvement at diagnosis is a critical prognostic factor in COVID-19-associated ROM. Early detection, judicious corticosteroid use, and aggressive management, including antifungal therapy and surgical debridement, are essential to improve survival. These findings underscore the need for stringent monitoring of high-risk patients, particularly those with diabetes, and highlight the importance of radiological assessment in guiding treatment decisions.