Journal
MYCOPATHOLOGIA
Volume 186, Issue 2, Pages 289-298Publisher
SPRINGER
DOI: 10.1007/s11046-021-00528-2
Keywords
Zygomycosis; Mucorales; Tocilizumab; Dexamethasone; Diabetes; CAPA
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The study discussed a case of probable pulmonary mucormycosis in a COVID-19 patient, highlighting the severity of the disease and the importance of aggressive management for better outcomes. A systematic review revealed that diabetes mellitus was the most common risk factor, and the concurrent use of glucocorticoids may also increase the risk of mucormycosis.
Severe coronavirus disease (COVID-19) is currently managed with systemic glucocorticoids. Opportunistic fungal infections are of concern in such patients. While COVID-19 associated pulmonary aspergillosis is increasingly recognized, mucormycosis is rare. We describe a case of probable pulmonary mucormycosis in a 55-year-old man with diabetes, end-stage kidney disease, and COVID-19. The index case was diagnosed with pulmonary mucormycosis 21 days following admission for severe COVID-19. He received 5 g of liposomal amphotericin B and was discharged after 54 days from the hospital. We also performed a systematic review of the literature and identified seven additional cases of COVID-19 associated mucormycosis (CAM). Of the eight cases included in our review, diabetes mellitus was the most common risk factor. Three subjects had no risk factor other than glucocorticoids for COVID-19. Mucormycosis usually developed 10-14 days after hospitalization. All except the index case died. In two subjects, CAM was diagnosed postmortem. Mucormycosis is an uncommon but serious infection that complicates the course of severe COVID-19. Subjects with diabetes mellitus and multiple risk factors may be at a higher risk for developing mucormycosis. Concurrent glucocorticoid therapy probably heightens the risk of mucormycosis. A high index of suspicion and aggressive management is required to improve outcomes.
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