Clinical case of mucormycosis in patient COVID-19. Case report

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Abstract

The COVID-19 epidemic is being revealed from a new angle every month. In particular, with the appearance of the delta strain, mucormycosis began to manifest in some patients, which had previously been extremely rare. Mucormycosis is a rare, aggressive infection caused by filamentous fungi of the Mucorales family and associated with high morbidity and mortality rates. The main risk factors for the mucormycosis in patients with COVID-19 are diabetes mellitus and diabetic ketoacidosis, uncontrolled hyperglycemia and massive use of glucocorticoids, vascular damage, thrombosis, lymphopenia, which often occur against the background of COVID-19 and make a person vulnerable to secondary or opportunistic fungal infection. We present a clinical case of mucormycosis in a 21-year-old female patient with COVID-19-associated severe pneumonia and concomitant type I diabetes mellitus. The patient was hospitalized and received standard therapy during inpatient treatment, including glucocorticosteroids in accordance with the severity of the course of COVID-19. On the 12th day from the hospitalization, the patient's condition deteriorated significantly, and the visible changes in the skin and soft tissues of the face, characteristic of mucormycosis appeared. Despite the drug therapy correction, the patient died because of the acute respiratory failure in combination with septic fungal damage of the brain stem.

About the authors

Guzel M. Nurtdinova

Bashkir State Medical University

Author for correspondence.
Email: guzel-doc@mail.ru
ORCID iD: 0000-0002-1662-821X

канд. мед. наук, доц. каф. пропедевтики внутренних болезней

Russian Federation, Ufa

Azat M. Suleymanov

City Clinical Hospital №21

Email: suleimanov_azat@mail.ru
ORCID iD: 0000-0002-9496-9618

канд. мед. наук, зав. отд-нием челюстно-лицевой хирургии

Russian Federation, Ufa

Ian I. Bayazitov

City Clinical Hospital №13

Email: ianian1987@mail.ru
ORCID iD: 0000-0002-8319-2356

врач-патологоанатом патологоанатомического отд-ния

Russian Federation, Ufa

Zarema R. Khismatullina

Bashkir State Medical University

Email: hzr07@mail.ru
ORCID iD: 0000-0001-8674-2803

д-р мед. наук, проф., зав. каф. дерматовенерологии с курсами дерматовенерологии и косметологии

Russian Federation, Ufa

Fanil B. Shamigulov

City Clinical Hospital Demsky district of Ufa

Email: fb.shamigulov@ya.ru
ORCID iD: 0000-0001-6597-6950

д-р мед. наук, проф., глав. врач

Russian Federation, Ufa

Ruslan M. Gumerov

Bashkir State Medical University; City Clinical Hospital Demsky district of Ufa

Email: rmgumerov@gmail.com
ORCID iD: 0000-0002-6110-0377

ассистент каф. пропедевтики внутренних болезней, зав. терапевтическим отд-нием

Russian Federation, Ufa; Ufa

Gulmira M. Agaidarova

City Clinical Hospital №21

Email: gulmir.ag@mail.ru
ORCID iD: 0000-0003-3792-5210

челюстно-лицевой хирург отд-ния челюстно-лицевой хирургии

Russian Federation, Ufa

Shamil Z. Zagidullin

Bashkir State Medical University

Email: zshamil@inbox.ru
ORCID iD: 0000-0002-7249-3364

д-р мед. наук, проф. каф. пропедевтики внутренних болезней

Russian Federation, Ufa

Sergey V. Shchekin

City Clinical Hospital №21

Email: schekinsv@yandex.ru
ORCID iD: 0000-0001-8339-7135

зав. патологоанатомическим отд-нием

Russian Federation, Ufa

Vlas S. Shchekin

City Clinical Hospital №21

Email: vlas-s@mail.ru
ORCID iD: 0000-0003-2202-7071

врач-патологоанатом патологоанатомического отд-ния

Russian Federation, Ufa

Dina F. Absalyamova

City Clinical Hospital Demsky district of Ufa

Email: absdina@yandex.ru
ORCID iD: 0000-0001-6286-5307

канд. мед. наук, зав. отд-нием

Russian Federation, Ufa

Valentin N. Pavlov

Bashkir State Medical University

Email: pavlov@bashgmu.ru
ORCID iD: 0000-0003-2125-4897

чл.-кор. РАН, д-р мед. наук, проф., ректор

Russian Federation, Ufa

Naufal Sh. Zagidullin

Bashkir State Medical University

Email: znaufal@mail.ru
ORCID iD: 0000-0003-2386-6707

д-р мед. наук, проф., зав. каф. пропедевтики внутренних болезней

Russian Federation, Ufa

References

  1. Gibson PG, Qin L, Puah S. COVID-19 acute respiratory distress syndrome (ARDS): clinical features and differences from typical pre-COVID-19 ARDS. Med J Aust. 2020;213(2):54-6. doi: 10.5694/mja2.50674
  2. Szarpak L, Wisco J, Boyer R. How healthcare must respond to ventilatorassociated pneumonia (VAP) in invasively mechanically ventilated COVID-19 patients. Am J Emerg Med. 2021;48:361-2. DOI:10.1016/j. ajem.2021.01.074
  3. Prakash H, Chakrabarti A. Global epidemiology of mucormycosis. J Fungi. 2019;5:26. doi: 10.3390/jof5010026
  4. Roden MM, Zaoutis TE, Buchanan WL, et al. Epidemiology and outcome of zygomycosis: A review of 929 reported cases. Clin Infect Dis. 2005;41(5):634-53. doi: 10.1086/432579
  5. Jeong W, Keighley C, Wolfe R, et al. The epidemiology and clinical manifestations of mucormycosis: a systematic review and metaanalysis of case reports. Clin Microbiol Infect. 2019;25:26-34. doi: 10.1016/j.cmi.2018.07.011
  6. Farmakiotis D, Kontoyiannis DP. Mucormycoses. Infect Dis Clin North Am. 2016;30:143-63. doi: 10.1016/j.idc.2015.10.011
  7. Cornely OA, Alastruey-Izquierdo A, Arenz D, et al. Global guideline for the diagnosis and management of mucormycosis: an initiative of the European Confederation of Medical Mycology in cooperation with the Mycoses Study Group Education and Research Consortium. Lancet Infect Dis. 2019;19:405-21. doi: 10.1016/S1473-3099(19)30312-3
  8. Mehta S, Pandey A. Rhino-orbital mucormycosis associated with COVID-19. Cureus. 2020;12(9):e10726. doi: 10.7759/cureus.10726
  9. Werthman-Ehrenreich A. Mucormycosis with orbital compartment syndrome in a patient with COVID-19. Am J Emerg Med. 2021;42:264.e5-8. doi: 10.1016/j.ajem.2020.09.032
  10. Skiada A, Pavleas I, Drogari-Apiranthitou M. Epidemiology and diagnosis of mucormycosis: an update. J Fungi. 2020;6(4):265. doi: 10.3390/jof6040265
  11. Ferguson BJ. Mucormycosis of the nose and paranasal sinuses. Otolaryngol Clin North Am. 2000;33(2):349-65. doi: 10.1016/s0030-6665(00)80010-9
  12. Challa S. Mucormycosis: Pathogenesis and pathology. Current Fungal Infection Reports. 2019;13(1):11-20. doi: 10.1007/s12281-019-0337-1
  13. Moorthy A, Gaikwad R, Krishna S, et al. SARS-CoV-2, uncontrolled diabetes and corticosteroids – an unholy trinity in invasive fungal infections of the maxillofacial region? A retrospective, multi-centric analysis. J Maxillofac Oral Surg. 2021;73:1-8. doi: 10.1007/s12663-021-01532-1
  14. Nehara HR, Puri I, Singhal V, et al. Rhinocerebral mucormycosis in COVID-19 patient with diabetes a deadly trio: case series from the north-western part of India. Indian J Med Microbiol. 2021;39(3):380-3. doi: 10.1016/j.ijmmb.2021.05.009
  15. Singh A, Singh R, Joshi S, Misra A. Mucormycosis in COVID-19: A systematic review of cases reported worldwide and in India. Diabetes Metab Syndr. 2021;15(4):102146. doi: 10.1016/j.dsx.2021.05.019

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2. Fig. 1. Brain computed tomography scan of the patient F. with COVID-19 and mucormycosis. Edema of soft tissues of peribulbar space. Left-sided maxillary sinusitis, ethmoiditis.

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3. Fig. 2. The configuration of the face has been changed due to soft tissue edema on the left, in the subglacial region on the left, an altered area of skin with clear uneven black contours is visualized on days on 14th (a) and 16th (b) days from the hospitalization in patient F.

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4. Fig. 3. Macroscopic autopsy of the patient F. with COVID-19 and mucormycosis: a – lung tissue. Edema and compaction of lung tissue with plethora, decreased airiness, hemorrhages, as a manifestation of the exudative stage of diffuse alveolar damage; b – cerebral meninges. There is a plethora of the soft meninges with a cloudy yellowish exudate between the furrows; c – brain stem. Small-point hemorrhages in the structures of the medulla oblongata with focal softening of the tissue; d – maxillary sinus from the side of the middle cranial fossa. Dark masses are visualized in the base of the maxillary sinus.

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5. Fig. 4: a – microscopy of the vessels of the meninges stained with hematoxylin-eosin (×400). In the lumen of the vessel, blood elements and fungi mycelium could be observed. The filaments of mushrooms are located both freely in the lumen of the vessel and fixed at the intima of the vessel; b – microscopy of the maxillary sinus. An accumulation of fungi mycelium, which is located in the edematous stroma with a some lymphoid infiltration.

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