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
Affiliations
Vidya Krishna
Department of Infectious Diseases, Immunology and BMT, Great Ormond Street Hospital, London, United Kingdom
Jaymin Morjaria
Department of Respiratory Medicine, Royal Brompton and Harefield Hospital, Guy’s and St.Thomas Hospital NHS Foundation Trust, London, United Kingdom
Rona Jalandari
Department of Cardiology, Royal Brompton and Harefield Hospital, Guy’s and St.Thomas Hospital NHS Foundation Trust, London, United Kingdom
Fatima Omar
Department of Cardiology, Royal Brompton and Harefield Hospital, Guy’s and St.Thomas Hospital NHS Foundation Trust, London, United Kingdom
Sundeep Kaul
Department of Respiratory Medicine, Royal Brompton and Harefield Hospital, Guy’s and St.Thomas Hospital NHS Foundation Trust, London, United Kingdom; Department of Intensive Care, Royal Brompton and Harefield Hospital, Guy’s and St.Thomas Hospital NHS Foundation Trust, London, United Kingdom; Corresponding author at: Consultant in Respiratory Medicine and Intensive Care, Harefield Hospital, Hill End Road, Harefield, Uxbridge, UB9 6JH, United Kingdom.
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.
