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Purpose: Amidst the ongoing coronavirus disease 2019 (COVID-19) pandemic, India experienced an epidemic of COVID-19–associated rhino-orbito-cerebral mucormycosis (ROCM). This study aimed to describe the epidemiology and elucidate the risk factors for developing COVID-19–associated ROCM, comparing the risk factors among COVID-19 patients with and without ROCM. Methods: This case–control study included all COVID-19–associated ROCM patients treated at our hospital from May 1 to July 30, 2021. Controls included age- and sex-matched COVID-19 patients without ROCM, who were treated during the same time (exact matching, in 1:2 ratio). Matched pair analysis using conditional logistic regression was performed to examine the association of various risk factors with the development of ROCM in COVID-19 patients. Results: The study included 69 patients with COVID-19–associated ROCM and 138 age- and gender-matched controls. Epidemiologically, COVID-19–associated ROCM predominantly affected males (59/69, 85%), in their early 50s (mean 52 years), with 48% (33/69) of patients being from medical resource-constrained settings. On multivariate conditional logistic regression, elevated serum glycated hemoglobin (HbA1c) (odds ratio [OR] = 1.36, 95% confidence interval [CI]: 1.03–1.78), blood glucose (OR = 1.008, 95% CI: 1.003–1.013), and C-reactive protein (CRP) (OR = 1.07, 95% CI: 1.02–1.17) were associated with increased odds of developing COVID-19–associated ROCM. Patients with undetected diabetes mellitus with increasing HbA1c (OR = 3.42, 95% CI: 1.30–9.02) and blood glucose (OR = 1.02, 95% CI: 1.005–1.03) (P = 0.02) had a higher probability of developing COVID-19–associated ROCM than patients with established DM. Conclusion: Uncontrolled DM evidenced by elevated HbA1c and blood glucose levels, exacerbated by COVID-19–induced proinflammatory state indicated by elevated CRP, is the principal independent risk factor for COVID-19–associated ROCM. Middle-aged males with undetected DM, from a resource-constraint setting, are particularly at risk.

Orbital Rhabdomyosarcoma is a lethal malignancy of childhood. It commonly presents in the first decade of life as a rapidly progressive proptosis that can mimic orbital inflammatory disorders. We present a case of a 13-year-old boy who presented with a diffuse right upper lid swelling progressing over 10 days. The detailed evaluation revealed an immobile, firm, and eyelid mass adhering to underlying tissues, not adherent to the skin. The provisional diagnosis of an orbital inflammation was performed. Neuroimaging suggested a preseptal cystic lesion. Intraoperatively, a solid bosselated mass arising from orbicularis oculi, extending into the anterior orbit was excised in toto. Histopathology revealed Stage-1 embryonal rhabdomyosarcoma, confirmed on immunohistochemistry. Postoperatively, the patient underwent systemic chemotherapy. The patient was tumor-free at 2 years follow-up.