A challenging complication following SARS-CoV-2 infection: a case of pulmonary mucormycosis
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CASE REPORT
A challenging complication following SARS‑CoV‑2 infection: a case of pulmonary mucormycosis Daniela Pasero1,2 · Silvana Sanna3 · Corrado Liperi1 · Davide Piredda1 · Gian Pietro Branca1,2 · Lorenzo Casadio2 · Raffaella Simeo2 · Alice Buselli2 · Davide Rizzo4 · Francesco Bussu2,4 · Salvatore Rubino3,5 · Pierpaolo Terragni1,2 Received: 8 July 2020 / Accepted: 23 November 2020 © The Author(s) 2020
Abstract Severe acute respiratory syndrome coronavirus 2 infection might induce a significant and sustained lymphopenia, increasing the risk of developing opportunistic infections. Mucormycosis is a rare but severe invasive fungal infection, mainly described in immunocompromised patients. The first case of a patient diagnosed with coronavirus disease (COVID-19) who developed a pulmonary mucormycosis with extensive cavitary lesions is here reported. This case highlights how this new coronavirus might impair the immune response, exposing patients to higher risk of developing opportunistic infections and leading to worse outcomes. Keywords SARS-Cov-2 · Mucormycosis · Opportunistic infections
Introduction Mucormycosis is a rare but severe invasive fungal infection occurring mainly in immunocompromised patients, especially in individuals diagnosed with uncontrolled diabetes mellitus or haematological malignancies, as well as in previously healthy subjects with open wounds contaminated by Mucorales [1–3]. Patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection might develop coronavirus disease (COVID-19), which can be associated to significant and sustained lymphopenia compromising the immune system, especially in the most severe cases [4–6]. Some authors described that a significant decrease in lymphocyte count and an increase of neutrophil count together * Daniela Pasero [email protected] 1
Intensive Care Unit, Emergency Department, AOU Sassari, Sassari, Italy
2
Department of Surgical Medical and Experimental Medicine, University of Sassari, Viale San Pietro 43, 07100 Sassari, Italy
3
Microbiology and Virology Units, AOU Sassari, Sassari, Italy
4
Otolaryngology Division, AOU Sassari, Sassari, Italy
5
Department of Biomedical Sciences, University of Sassari, Sassari, Italy
with an inflammatory storm, occur more frequently in patients who developed severe COVID-19 and co-infections [4]. This report describes the first case of a patient with SARS-CoV-2 infection who developed a cavitary pulmonary mucormycosis.
Case report A 66-year-old male patient was admitted to ICU at the University Hospital, in Sassari, Italy, on March 26, 2020, with a diagnosis of SARS-CoV2 infection. Due to a rapid and progressive deterioration of oxygenation, the patient was intubated after a short period of non-invasive respiratory support. He had a history of arterial hypertension treated with ACE-inhibitors and had recently been diagnosed with urinary tract infection. The beginning of COVID-19 symptoms reportedly started one week before admission. A therapy with hydroxychloroquine and lopina
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