Abstract:

Mucormycosis is an invasive fungal infection caused by opportunistic fungi of the Family Mucoraceae. It usually affects poorly controlled diabetic and immunocompromised patients. Geographically this infection is confined mainly to tropical regions of South America, Africa, and Asia. We hereby report a patient who contracted COVID-19 complicated later by cutaneous mucormycosis in the USA. 56 Years old white female with history of obesity, DM, deceased kidney transplant in February 2021, who contracted COVID-19 infection about 3 months into her transplant with moderate symptoms requiring hospitalization. Multiple subcutaneous tender indurated nodules started to show up on the extensor surfaces of arms and legs about 2-3 weeks after COVID 19 pneumonia treatment, these nodules ranged in size between 0.8- 2 cm. These lesions became necrotic with erythematous halo. The patient remained in her usual state of health until the biopsy was obtained and revealed aseptate large, broad, ribbon-like hyphae with characteristic right-angle branching, surrounded by granulomatous tissue reaction, sparse dermal inflammation, neutrophilic abscesses, tissue necrosis, and angioinvasion. The patient deteriorated into disseminated Mucormycosis with pulmonary involvement and succumbed to her disease in spite of aggressive anti-fungal treatment. The so-called black fungus was featured in case series from India in COVID-19 patients during the pandemic. A 2021 systematic review of all COVID-19-related cases published in the scientific literature found 101 cases: 82 of them in India and 19 from the rest of the world. Among these cases, 31% were fatal. Singh et al report that 60% of all the cases occurred during an active SARS-CoV-2 infection and that 40% occurred after recovery. In total, 80% of the patients had diabetes, and 76% had been treated with corticosteroids. We argue that using corticosteroids during SARS-CoV-2 should be rationed in transplant and immunocompromised people.

Financial Disclosure:
No current or relevant financial relationships exist.

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Ana Lia Castellanos, MD