Mucormycosis after Coronavirus disease 2019 infection in a heart transplant recipient - Case report and review of literature

Abstract

Mucormycosis is an invasive fungal infection (IFI) due to several species of saprophytic fungi, occurring in patients with underlying co-morbidities (including organ transplantation). During the ongoing Coronavirus disease 2019 (COVID-19) pandemic, there have been increasing reports of bacterial and fungal co-infections occurring in COVID-19 patients, including COVID-19 associated pulmonary aspergillosis (CAPA). We describe a case of mucormycosis occurring after COVID-19, in an individual who received a recent heart transplant for severe heart failure. Two months after heart transplant, our patient developed upper respiratory and systemic symptoms and was diagnosed with COVID-19. He was managed with convalescent plasma therapy and supportive care. Approximately three months after COVID-19 diagnosis, he developed cutaneous mucormycosis at an old intravascular device site. He underwent extensive surgical interventions, combined with broad-spectrum antifungal therapy. Despite the aggressive therapeutic measures, he died after a prolonged hospital stay. In this case report, we also review the prior well-reported cases of mucormycosis occurring in COVID-19 patients and discuss potential mechanisms by which COVID-19 may predispose to IFIs. Similar to CAPA, mucormycosis with COVID-19 may need to be evaluated as an emerging disease association. Clinicians should be vigilant to evaluate for invasive fungal infections such as mucormycosis in patients with COVID-19 infection.

Keywords: Cardiac transplant; Coronavirus disease 2019 (COVID-19); Mucormycosis; Rhizopus microsporus; SARS-CoV-2; Zygomycosis.

Fig. 1

Computed tomography (CT) scan–transverse view of thoracic cavity. Fluid collection noted in right anterior chest wall (red arrow), with inflammatory infiltrate in surrounding tissues (blue arrows). The letter P denotes the posterior orientation of the patient.

Fig. 2

Computed tomography (CT) scan–transverse view of thoracic cavity. A right subclavian artery pseudoaneurysm is noted adjacent to the right chest wall collection (yellow arrow). The letter P denotes the posterior orientation of the patient.