Fig. 5

A 60-year-old female patient presented with left proptosis, visual loss, total ophthalmoplegia and left facial pain after 3 weeks of COVID-19 infection with poor diabetic control. A, B CT coronal images show mucosal thickening of the left maxillary sinus (white asterisk) and left nasal cavity (green asterisks). C MRI coronal T2WI shows stranding in the orbit fat, involvement of left nasal cavity (black turbinate sign). D MRI axial contrast-enhanced T2WI with fat suppression image shows non-enhancement and thickening of left optic nerve (white arrowhead), hypointense soft tissue intensity in left orbital apex (red arrowheads) with orbital fat stranding. E–G Coronal contrast-enhanced T1WI shows left leptomeningeal thickening and enhancement along the floor of the middle cranial fossa and abnormal enhancement in the left temporal lobe, left cavernous sinus (dashed arrows). Meckel’s cave is infiltrated with extension along the left mandibular nerve (white dashed circle) to infratemporal fossa, mucosal thickening of the left sphenoid sinus (yellow asterisks), and nasopharynx (thick arrow). H Operative view shows necrosis of the facial soft tissue and sinus. Patient underwent aggressive debridement in the form of left total maxillectomy and left orbit exenteration, patient survived after proper diabetic control and IV amphotericin B administration