Pulmonary embolism and gastric bleed with disseminated mucormycosis - treading dangerous waters

Abstract

Mucormycosis is an opportunistic infection seen in immunocompromised patients or in surgical and trauma settings with Mucorales wound contamination. In immunocompetent people, disseminated mucormycosis is uncommon. To ensure survival, patients with mucormycosis require early diagnosis and aggressive treatment using a multi-modality approach. We present a case of disseminated mucormycosis in an immunocompetent patient who also had pulmonary embolism and gastrointestinal bleeding. A recent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, identified retrospectively by a positive IgM against SARS-CoV-2, was the only risk factor present. This report emphasizes the increased risk of mucormycosis and thromboembolic complications following a recent SARS-CoV-2 infection, as well as its successful treatment with medical therapy alone.

COVID-19 associated mucormycosis a recent challenge

“… 12 Recent articles on COVID-19-associated mucormycosis (CAM) have been published. 3 - 6 , 8 , 9 It is estimated a higher prevalence of CAM than the reported cases because of the lack of population-based research. Thus, CAM cases may be higher than the described ones.…”

“…Chauhan et al 3 reported a 35-year-old man with fever, vomiting, delirium, dyspnea, and cough, in addition to melena. Pulmonary thromboembolism and bilateral ground glass opacities were revealed by chest imaging study.…”

“…Treatment of this patient included posaconazole evolving to an asymptomatic clinical status and complete vanishing of the CNS lesions. 3 Worthy of note is the disseminated mucormycosis in the absence of any apparent risk factor, except for COVID-19 infection that has been associated with prothrombotic conditions. 3 Malakar et al 8 described an 82-year-old man with GI bleeding for five days who utilized prednisolone for 21 days to treat moderate COVID-19 infection 2 months ago.…”

“… 3 Worthy of note is the disseminated mucormycosis in the absence of any apparent risk factor, except for COVID-19 infection that has been associated with prothrombotic conditions. 3 Malakar et al 8 described an 82-year-old man with GI bleeding for five days who utilized prednisolone for 21 days to treat moderate COVID-19 infection 2 months ago. The upper GI endoscopy detected a gastric ulcer extending from the gastroesophageal junction, and biopsy studies showed fungal hyphae consistent with gastric mucormycosis.…”