A Rare Case of Isolated Vesical Mucormycosis in a Patient with COVID-19 Pneumonitis

Abstract

We present the case of a 60-year-old diabetic female who was diagnosed with coronavirus disease 2019 (COVID-19) pneumonitis. After her recovery during follow-up, she presented with recurrent hematuria, burning of micturition and, occasional lower abdominal discomfort, with unsatisfactory response to oral antibiotics. On imaging evaluation, there was mild right hydronephrosis and hydroureter with urothelial thickening involving the right lower ureter and a filling defect in the urinary bladder close to the vesicoureteric junction seen on excretory phase images. Cystoscopy revealed a whitish friable mass-like lesion that was retrieved, histopathology of which revealed fungal elements, and Rhizopus was isolated in culture. Thus, the diagnosis of urinary bladder fungal ball due to mucormycosis infection of the urinary tract was reached. The patient was asymptomatic after 10 weeks of antifungal treatment. The treating physicians, urologist, and radiologists need to have a high index of suspicion of urinary mucormycosis in patients with COVID-19 pneumonia.

Uncommon Haemorrhagic Cystitis of Infectious Origin: A Narrative Review for Urologists

“…Mucorales, Cryptococcus neoformans, Aspergillus fumigatus, and Torulopsis glabrata may be associated with haemorrhagic cystitis. 28 , 29 Muthe et al reported the case of a 60-year-old diabetic woman diagnosed with a mucormycosis infection of the urinary tract presenting with LUTS and recurrent hematuria during SARS-CoV-2 infection. 20 Rhizopus species was detected in a fungus-ball-specimen retrieved during cystoscopy in a patient with haemorrhagic cystitis.…”