Post covid pulmonary mucormycosis, early interventions surgical complications and outcome

ABSTRACT

Background: Invasive fungal infections are an important cause of morbidity and mortality in immunocompromised patients. These infections remain difficult to diagnose and their management is complicated by their aggressive course of disease. Discussion: A 50yrs old female, case of rheumatoid arthritis on treatment, post covid presented in a state of DKA with complaints of fever, cough, breathlessness and right sided pleuritic chest pain for >1 month with 2-3 episodes of minimal hemoptysis. CXR s/o Right middle lobe cavity lesion. Bronchoscopy Right UL bronchial segments inflamed, irregular sloughed mucosa with endobronchial narrowing, biopsy obtained. HPE s/o mucormycosis Patient started on IV antibiotics & antifungals. Thoracotomy- Right upper and middle lobectomy done on day 8 of hospitalization. Right upper lobe had two large necrotic thick walled cavities with blackish slough. On post-op day 4 patient developed large air leak in ICD s/o BPF. Second thoracotomy for BPF repair done after 7weeks of 1stsurgery. Patient had respiratory distress after extubation. CXR showed right opaque hemithorax with pull of mediastinum. Required urgent bronchoscopy to remove endobronchial mucus plug. Conclusion: Prognosis and outcome have improved as a result of early diagnosis, newer antifungals agents & surgical debridement. Antifungal treatment, surgical interventions & high risk of post surgical complications in an immunocompromised elderly host is grave challenge. But our case had a positive clinical outcome.