Abdominal Wall Fungal Co-infection-Mucormycosis Associated with COVID-19: A Case Report

ABSTRACT

Aim and objective: To present a rare case of abdominal wall fungal coinfection with Mucormycosis in a patient of COVID-19. Materials and methods: A 33-year-old female operated case of laparoscopic ectopic pregnancy removal with salpingectomy and tubectomy, at postoperative day 5 had redness and pus discharge from the operative site and was diagnosed with abdominal wall cellulitis. She underwent local exploration and wound wash. On postoperative day 21, the patient came to the emergency room with cellulitis, and pain at the port insertion site. On examination, we highlight BP 90/50 mm Hg and blood test analysis with HB-8.3, leucocyte count 29.91 × 109/L, CRP 333 mg/L. Results: CT scan revealed necrotizing fasciitis. She underwent wide local excision and debridement. Post debridement the next day during dressing, the wound showed a cotton fluffy appearance at the edges and part of the base with black necrotic areas. A wound swab was sent for fungal culture, KOH mount, pus culture, and tissue for histopathology. In the meantime, she was started on empirical antifungal amphotericin B, meropenem, and minocycline antibiotics. On history, the patient remarked that she did have fever, sore throat, and cough for 5 days, 4 weeks before laparoscopic ectopic pregnancy removal. Also one of her family members had tested positive for COVID-19. COVID antibodies test was done which were reactive 1.96. Tissue histopathology revealed mucormycosis. MRI abdomen findings showed a 15 cm large defect involving the entire thickness of subcutaneous fat. A high degree of suspicion and promptness in starting antifungal treatment prevented the fatal outcome. Conclusion: COVID-19 is associated with immune dysregulation and consequently life-threatening infections. The prolonged and indiscriminate use of steroids for the treatment of COVID-19 could contribute to this problem of fungal superinfection of mucormycosis. It seems prudent to have a very high suspicion supplemented with thorough clinical examination and low threshold for imaging in order to diagnose secondary fungal infections, such as mucormycosis. Early so that the treatment can be instituted as soon as possible.