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Case Reports
. 2022 Mar;32(1):101228.
doi: 10.1016/j.mycmed.2021.101228. Epub 2021 Nov 18.

Pulmonary mucormycosis in the aftermath of critical COVID-19 in an immunocompromised patient: Mind the diagnostic gap

Cornelia Geisler Crone  1 , Jannik Helweg-Larsen  2 , Morten Steensen  3 , Maiken Cavling Arendrup  4 , Marie Helleberg  5
Affiliations
Case Reports

Pulmonary mucormycosis in the aftermath of critical COVID-19 in an immunocompromised patient: Mind the diagnostic gap

Cornelia Geisler Crone et al. J Mycol Med. 2022 Mar.

Abstract

Mucormycosis has recently been recognized as a severe complication of COVID-19 with high fatality rates. We report a fatal case of COVID-19 associated mucormycosis (CAM) in a non-diabetic immunocompromised patient, who was first misdiagnosed and treated for COVID-19 associated aspergillosis (CAPA). The risk factors and initial clinical presentation of CAPA and CAM are similar, but CAM has a more aggressive course and CAPA and CAM are treated differently. Dedicated diagnostic workup is essential to ensure early treatment of CAM with surgical debridement and targeted antifungal therapy.

Keywords: COVID-19; Immunosuppression; Invasive fungal infection; Mucormycosis; Rhizopus microsporum; SARS-COV-2.

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Conflict of interest statement

Declaration of Competing Interest The authors CGC and JHL have no conflicts of interest. The author MS has the following conflict of interest: Outside the current work, MS has received speaker honoraria (personal fees) from Gilead and MSD. The author MCA has the following conflict of interest: MCA has, over the past 5 years, received research grants/contract work (paid to the SSI) from Amplyx, Basilea, Cidara, F2G, Gilead, Novabiotics, Scynexis and T2Biosystems and speaker honoraria (personal fees) from Astellas, Gilead, Novartis, MSD, and SEGES. She is the current chairman of the EUCAST-AFST. The author MH has the following conflict of interest: MH has received travel grants from Gilead and GSK, speaker's honorarium from GSK, MSD and Gilead, research grant from Takeda, and has participated in advisory boards for GSK, Gilead, MSD, AstraZenica and Sobi.

Figures

Fig. 1
Fig. 1
Timeline of inflammatory markers, blood glucose and medication in a patient with COVID-19 associated mucormycosis. Microbiological findings: orange asterisk = positive SARS-COV-2 by PCR (cycle threshold values available: day 18 = 24, day 20 = 24, day 26 = 28), dark green triangle = galactomannan index blood 1.5; light green triangle = galactomannan index BAL-F 0.6; red square = Rhizopus microsporum in culture of sputum. pink diamonds = Time of computed tomography (CT) CRP = C-reactive protein, FER = ferritin Hyperglycemia ≥11.0 mmol/L.
Fig. 2
Fig. 2
Radiological findings of pulmonary COVID-19 associated mucormucosis. A: High resolution computed tomography (CT) scan day 27 after first admission. B: CT scan day 53 after first admission.
See this image and copyright information in PMC

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