Diagnostic Dilemma in Renal Transplant Covid-19 Positive Patient - A Case Report

Abstract

INTRODUCTION: Covid 19 infection is caused by SARS-COVID virus and responsible for pandemic in 2020. Most common signs and symptoms include fever, cough, lower respiratory tract infection etc. CASE REPORT: A 51 year old male patient, a known case of diabetes, hypertension and chronic renal disease with renal transplant 3 years back and on immunosuppressive drugs was complaining of high degree fever, myalgia, fatigue, abdominal pain, more over the left upper abdomen. USG shows Hypoechoic collection in the inferior pole of spleen measuring 5x6cm with mild perisplenic collection, suggestive of splenic abscess. The patient had undergone emergency laparotomy of splenectomy. On histopathology, refractile, aseptate, broad angle fungal hyphae suggestive of Mucormycosis. PAS stain was Positive. DISCUSSION: Spleen is a rare site for fungal infection. With superadded COVID 19 infection and bilateral basal consolidation in the lungs, the underlying splenic lesion will be confused as part of thromboembolic episodes rather than fungal infection. Hence, delay in treatment of antifungal drugs will lead to mortality in such cases. CONCLUSION: In COVID 19 infections, the rare manifestation of fungal infection to be considered while treating the immunosuppressive patients.