Mixed Infections (Mucormycosis, Actinomycosis and Candidiasis) Leading to Maxillary Osteomyelitis in a Diabetic Mellitus Patient in Post COVID Phase: First Case Report

Background: The second wave of COVID-19 has emerged with the addition of vivid types of oral manifestations. Immunosuppression caused by COVID-19 results in an exacerbation of pre-existing infections. Recently, in the backdrop of COVID-19 expression, a notable rise in the incidence of secondary infections, both fungal and bacterial, have been reported either during the disease or as a post-COVID manifestation. Case presentation: A 70-year-old male diabetic COVID-19 patient reported with a chief complaint of pain in the right side maxillary region for 3 months and the passage of content from the oral cavity into the nose. Intraoral examination revealed missing teeth i.r.t. 12 to 17, denuded mucosa with exposed necrotic bone and an oroantral opening. Sequestrectomy was done and the tissue was sent for histopathological examination which revealed necrotic bone interspersed with broad aseptate fungal hyphae branched at right angles along with actinomycotic colonies and Candidal hyphae in few areas. Based on histopathological findings, a final diagnosis of mixed infections leading to Maxillary Osteomyelitis was given. No recurrence was noticed after 3 months of follow up. Conclusions: The occurrence of oral infections even after the remission period of COVID-19 signifies an alarming sign both for the patient and clinicians monitoring the oral health status during the follow-up period. To our knowledge, this is the first such case (three oral infections as a post covid manifestation in a single diabetic patient) reported in the literature till date.