Post-COVID mixed fungal infection - A case report and review of literature

In the COVID-19 pandemic era, an increasing number of cases of mucormycosis have been associated with COVID-19. Mucormycosis is an invasive fungal infection in the background of immunosuppression state. COVID-19 and its treatment cause immunosuppression in patients. Mucormycosis commonly causes necrosis in the nose, paranasal sinuses, and facial bones and may also spread into the brain and lungs. A 58-year-old male, who was a known case of diabetes mellitus, was admitted with COVID-19 reverse transcription-polymerase chain reaction positive and B/L GGO with 50% lung involvement in computed tomography (CT) chest, treated as per protocol, and discharged. After 2 weeks of discharge patient presented with hemoptysis, cough with expectoration and breathlessness. Patient was admitted and stabilized. CT chest taken showed right (Rt) upper lobe and lower lobe mucormycosis and left (Lt) upper lobe and lower lobe aspergilloma. Fiberoptic bronchoscopy was done and bronchial wash taken then sent for fungal KOH and culture.fungal culture report showed mixed fungal infection like mucormycosis and aspergilloma. Patient treated with tablet posaconazole and other supportive measures and discharged. Patient asked to review every month. Followup CT chest taken at 1 month and end of 5 months. CT chest revealed partial resolution of Rt upper and lower lobe mucormycosis and persistence of Lt upper and lower lobe aspergilloma lesions. The patient persistently had hemoptysis and hence was referred to cardiothoracic surgery for surgical management of aspergilloma. COVID-19 and treatment of COVID-19 cause underlying immunosuppression that leads to fungal infections such as mucormycosis and aspergilloma. Early identification and treatment of fungal infection reduce morbidity and mortality.