Two Uncommon Presentations of COVID-19-Associated Mucormycosis

Area of Science:

• Mycology
• Infectious Diseases
• Critical Care Medicine

Background:

• Mucormycosis is a rare, opportunistic fungal infection primarily affecting immunocompromised individuals.
• A significant increase in mucormycosis cases, particularly rhino-orbital, was observed during the second wave of Coronavirus Disease 2019 (COVID-19) in India.
• Mucormycosis has been frequently reported as a concurrent or post-recovery complication of COVID-19 pneumonia.

Observation:

• This report presents two distinct cases of COVID-19-associated mucormycosis (CAM) in patients with recent COVID-19 recovery.
• The first patient, an uncontrolled diabetic, presented with Fournier's gangrene, later diagnosed as mucormycosis.
• The second patient, also an uncontrolled diabetic with prior COVID-19, developed pulmonary mucormycosis and aspergillosis, complicated by a gastropleural fistula.

Findings:

• Both patients received liposomal amphotericin B (L-ampB) treatment.
• Despite treatment, both patients experienced significant clinical deterioration due to the severe nature of their infections.
• These cases highlight unusual presentations of CAM, including Fournier's gangrene and concurrent pulmonary aspergillosis with fistula formation.

Implications:

• The findings underscore the diverse and severe manifestations of COVID-19-associated mucormycosis.
• Early recognition and aggressive management are crucial for improving outcomes in these complex cases.
• Further research is needed to understand the pathogenesis and optimize treatment strategies for CAM, especially in patients with underlying conditions like diabetes.