SHM Converge Scientific Abstract ePoster Gallery-Devastations of Black Fungus in a Covid-19 Patient

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A 44-year-old unvaccinated man with psoriatic arthritis on guselkumab and asthma presented with 10 days of worsening shortness of breath and 3 days of midsternal chest pain after recently testing positive for COVID-19. On arrival, he was afebrile and mildly hypoxic despite 5 L nasal cannula. Labs showed elevated CRP, and CT chest revealed multifocal bilateral airspace disease, tiny bilateral apical pneumothoraces, and extensive pneumomediastinum.<br /><br />He was treated with dexamethasone, remdesivir, and broad-spectrum antibiotics, but his course deteriorated into ARDS requiring mechanical ventilation. Bronchoalveolar lavage cytology showed fungal hyphae, and fungal culture grew Mucorales, later identified as Lichtheimia corymbifera. CT sinus and ENT nasal endoscopy showed no evidence of invasive rhino-orbital disease. He was started on amphotericin B and posaconazole, then transitioned to isavuconazole pending sensitivity results. He eventually improved, was weaned from the ventilator, completed inpatient rehabilitation, and returned home doing well, with a plan to continue isavuconazole for at least 6 months.<br /><br />This case highlights the risk of secondary fungal infection, particularly mucormycosis, in patients with COVID-19. Immune dysregulation from COVID-19, along with treatment with steroids, monoclonal antibodies, and broad-spectrum antibiotics, may contribute to fungal coinfection or reactivation of underlying disease. Because mucormycosis can be difficult to diagnose and carries high mortality, clinicians should maintain a high index of suspicion in COVID-19 patients with persistent fever, hypoxemia, or clinical deterioration.

Asset Subtitle

Tissa Bijoy George

Meta Tag

Author List Faizan a Faizee, Meghan Fitzpatrick, Tissa Bijoy George

Category Clinical Vignettes

Concept COVID-19associated pulmonary mucormycosis

Concept Pulmonary mucormycosis

Concept Antifungal Therapy

Concept Radiologic Findings

Concept Risk Factor

Distinguished Non-Finalist

Presenter Organization Upmc

Presenting Author Tissa Bijoy George

Track Adult

Keywords

COVID-19

mucormycosis

Lichtheimia corymbifera

fungal coinfection

ARDS

pneumomediastinum

amphotericin B

isavuconazole

psoriatic arthritis

immunosuppression

COVID-19associated pulmonary mucormycosis

Pulmonary mucormycosis

Antifungal Therapy

Radiologic Findings

Risk Factor