Post-COVID-19 Disease Associated with Mucormycosis and Guillain-Barré Syndrome: A Causal Association or Just a Coincidence?

Abstract

Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2).
Originating from Wuhan, China, COVID-19 has rapidly spread worldwide. COVID-19 is primarily considered to be a
respiratory illness, but with time there is enough evidence about the extrapulmonary manifestations of the disease. One of
the neurological manifestations is Guillain-Barré syndrome (GBS). It may be associated with mucormycosis, with majority
of cases occurring in India. Here, we report a case of a 40-year-old male patient, a known case of hypertension and diabetes
mellitus who presented with the complaints of fever, cough and shortness of breath since May 10, 2021. He was found to be
RT-PCR positive for COVID-19 on May 12, 2021. While recovering from COVID-19, on May 25, he was suspected to have
rhino-orbital mucormycosis, which was confirmed on tissue specimen. While recovering from rhino-orbital mucormycosis,
on July 26, the patient complained of weakness in bilateral lower limbs, followed by weakness in both upper limbs after
2 days. GBS was confirmed on nerve conduction study (NCS) and cerebrospinal fluid (CSF) examination. Patient was treated
with intravenous immunoglobulin (IVIG), and while on treatment, the patient showed no significant improvement. Invasive
ventilation was started in view of respiratory muscle involvement. The patient also developed autonomic dysfunction.
He went into cardiac arrest and despite best efforts, couldn’t be revived. Currently, to the best of our knowledge, there is
no data to tell that both mucormycosis and GBS can occur in association with COVID-19. This case aims to raise awareness
among the healthcare providers for this type of association. COVID-19 may be a cause or it may just be a mere coincidence,
needs further study