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Case Reports
. 2021 Aug;64(8):798-808.
doi: 10.1111/myc.13256. Epub 2021 Mar 5.

The double-edged sword of systemic corticosteroid therapy in viral pneumonia: A case report and comparative review of influenza-associated mucormycosis versus COVID-19 associated mucormycosis

Kazem Ahmadikia  1 , Seyed Jamal Hashemi  1 , Sadegh Khodavaisy  1 , Muhammad Ibrahim Getso  2 , Neda Alijani  3 , Hamid Badali  4   5 , Hossein Mirhendi  6 , Mohammadreza Salehi  7 , Azin Tabari  8 , Mojtaba Mohammadi Ardehali  9 , Mohammad Kord  1 , Emmanuel Roilides  10 , Sassan Rezaie  1
Affiliations
Case Reports

The double-edged sword of systemic corticosteroid therapy in viral pneumonia: A case report and comparative review of influenza-associated mucormycosis versus COVID-19 associated mucormycosis

Kazem Ahmadikia et al. Mycoses. 2021 Aug.

Abstract

Acute respiratory distress syndrome is a common complication of severe viral pneumonia, such as influenza and COVID-19, that requires critical care including ventilatory support, use of corticosteroids and other adjunctive therapies to arrest the attendant massive airways inflammation. Although recommended for the treatment of viral pneumonia, steroid therapy appears to be a double-edged sword, predisposing patients to secondary bacterial and invasive fungal infections (IFIs) whereby impacting morbidity and mortality. Mucormycosis is a fungal emergency with a highly aggressive tendency for contiguous spread, associated with a poor prognosis if not promptly diagnosed and managed. Classically, uncontrolled diabetes mellitus (DM) and other immunosuppressive conditions including corticosteroid therapy are known risk factors for mucormycosis. Upon the background lung pathology, immune dysfunction and corticosteroid therapy, patients with severe viral pneumonia are likely to develop IFIs like aspergillosis and mucormycosis. Notably, the combination of steroid therapy and DM can augment immunosuppression and hyperglycaemia, increasing the risk of mucormycosis in a susceptible individual. Here, we report a case of sinonasal mucormycosis in a 44-year-old woman with hyperglycaemia secondary to poorly controlled diabetes following dexamethasone therapy on a background of influenza pneumonia and review 15 available literatures on reported cases of influenza and COVID-19 associated mucormycosis.

Keywords: COVID-19; corticosteroid therapy; influenza; mucormycosis; viral pneumonia.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

FIGURE 1
FIGURE 1
Axial view of chest computed tomography (CT) scan revealing peripheral bilateral ground‐glass opacities
FIGURE 2
FIGURE 2
CT of paranasal sinuses illustrating maxillary sinus mucosal thickening
FIGURE 3
FIGURE 3
KOH examination (A) and haematoxylin and eosin (H&E) stain (B) showed abundant aseptate hyphae in the affected organs. Broad‐angled, aseptate hyphae were diagnostic of mucormycosis
See this image and copyright information in PMC

References

    1. WHO , Influenza (seasonal) fact sheet. 2018, World Health Organisation Media Centre Geneva.
    1. WHO . Coronavirus disease 2019 (COVID‐19). https://covid19.who.int/2020
    1. Cao B, Gao H, Zhou B, et al. Adjuvant corticosteroid treatment in adults with influenza A (H7N9) viral pneumonia. Crit Care Med. 2016;44(6):e318‐e328. - PubMed
    1. Salehi M, Ahmadikia K, Mahmoudi S, et al. Oropharyngeal candidiasis in hospitalised COVID‐19 patients from Iran: species identification and antifungal susceptibility pattern. Mycoses. 2020;63(8):771‐778. - PMC - PubMed
    1. Alhazzani W, Møller MH, Arabi YM, et al. Surviving sepsis campaign: Guidelines on the management of critically ill adults with Coronavirus Disease 2019 (COVID‐19). Int Care Med 2020;46(5):854‐887. - PMC - PubMed