Autoptic identification of disseminated mucormycosis in a young male presenting with cerebrovascular event, multi-organ dysfunction and COVID-19 infection

Vidya Krishna; Jaymin Morjaria; Rona Jalandari; Fatima Omar; Sundeep Kaul

doi:10.1016/j.idcr.2021.e01172

Autoptic identification of disseminated mucormycosis in a young male presenting with cerebrovascular event, multi-organ dysfunction and COVID-19 infection

IDCases. 2021:25:e01172. doi: 10.1016/j.idcr.2021.e01172. Epub 2021 May 28.

Authors

Vidya Krishna¹, Jaymin Morjaria², Rona Jalandari³, Fatima Omar³, Sundeep Kaul^{2

4}

Affiliations

¹ Department of Infectious Diseases, Immunology and BMT, Great Ormond Street Hospital, London, United Kingdom.
² Department of Respiratory Medicine, Royal Brompton and Harefield Hospital, Guy's and St.Thomas Hospital NHS Foundation Trust, London, United Kingdom.
³ Department of Cardiology, Royal Brompton and Harefield Hospital, Guy's and St.Thomas Hospital NHS Foundation Trust, London, United Kingdom.
⁴ Department of Intensive Care, Royal Brompton and Harefield Hospital, Guy's and St.Thomas Hospital NHS Foundation Trust, London, United Kingdom.

Abstract

Among the secondary fungal infections in Coronavirus-19 (COVID-19) infection, Aspergillosis has been reported more often than Mucormycosis. Disseminated mucormycosis is almost always a disease of severely immunosuppressed hosts. We report a young obese Asian male who was admitted with an acute anterior cerebral artery (ACA) territory infarct and severe COVID-19 pneumonitis to the intensive care unit (ICU). He had a complicated stay with recurrent episodes of vasoplegic shock and multi-organ dysfunction. At autopsy, he was confirmed to have disseminated mucormycosis. We believe this to be the first documented case of disseminated mucormycosis in an immunocompetent host with COVID-19 infection. The lack of sensitive non-invasive modalities and biomarkers to diagnose mucormycosis, along with the extremely high mortality in untreated cases, present a unique challenge to clinicians dealing with critically ill patients with COVID-19.

Keywords: COVID-19; Fungal; Mucormycosis; Secondary infections.

Publication types

Case Reports