Acute and Critical Care

Case Report

Pulmonary
A fatal case report of invasive pulmonary aspergillosis and mucormycosis coinfection in an immunocompetent patient with coronavirus disease 2019 in Korea: Jin Hyoung Kim, Misung Kim, Soyeoun Lim, Sun Young Park, Yangjin Jegal, Taehoon Lee, Byung Ju Kang; Acute Crit Care. 2023;38(3):382-388. Published online June 27, 2022; DOI: https://doi.org/10.4266/acc.2021.01340

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Systemic glucocorticoid treatment is highly recommended in critically ill coronavirus disease 2019 (COVID-19) patients. However, secondary fungal infections are of concern in such patients. Here, we describe the first case of COVID-19-associated invasive pulmonary aspergillosis (CAPA) and COVID-19-associated mucormycosis (CAM) coinfection in a COVID-19 positive immunocompetent patient in Korea. A 69-year-old man was admitted to our hospital with COVID-19 pneumonia. He had no underlying comorbidities and was not taking medications. He received remdesivir, dexamethasone, and antibiotic therapy under mechanical ventilation. Although his condition improved temporarily, multiple cavities were observed on chest computed tomography, and Aspergillus fumigatus was cultured from tracheal aspiration culture. He was diagnosed with probable CAPA and received voriconazole therapy. However, his condition was not significantly improved despite having received voriconazole therapy for 4 weeks. After release from COVID-19 quarantine, he underwent bronchoscopy examination and was then finally diagnosed with CAPA and CAM coinfection on bronchoscopic biopsy. Antifungal treatment was changed to liposomal amphotericin B. However, his progress deteriorated, and he died 4 months after admission. This case highlights that clinical suspicion and active checkups are required to diagnose secondary fungal infections in immunocompetent COVID-19 patients who receive concurrent glucocorticoid therapy.

Citations

Citations to this article as recorded by

Mixed Aspergillosis and Mucormycosis Infections in Patients with COVID-19: Case Series and Literature Review
Elahe Sasani, Farzad Pakdel, Sadegh Khodavaisy, Mohammadreza Salehi, Amir Salami, Marjan Sohrabi, Pouyan Aminishakiba, Iman Amirafzali, Arezoo Salami Khaneshan
Mycopathologia.2024;[Epub] CrossRef
Dual Disseminated Aspergillosis and Mucormycosis Diagnosed at Autopsy: A Report of Two Cases of Coinfection and a Review of the Literature
Jason Murray, Zhen A. Lu, Karin Miller, Alex Meadows, Marissa Totten, Sean X. Zhang
Journal of Fungi.2023; 9(3): 357. CrossRef
COVID-19 and Fungal infections: a double debacle
Sara Mina, Hajar Yaakoub, Cédric Annweiler, Vincent Dubée, Nicolas Papon
Microbes and Infection.2022; 24(8): 105039. CrossRef

Original Article

Pulmonary
The Role of Transbronchial Lung Biopsy in Diagnosing Pulmonary Mucormycosis in a Critical Care Unit: Yoonki Hong, Jinkyeong Park; Korean J Crit Care Med. 2017;32(2):205-210. Published online May 31, 2017; DOI: https://doi.org/10.4266/kjccm.2017.00150

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Abstract PDF: Background
Pulmonary mucormycosis (PM) is an emerging infectious disease and a life-threatening infection with high mortality. The clinical outcomes of PM have not improved significantly over the last decade because early diagnosis of PM is difficult and antifungal agents show limited activity. We evaluated the clinical manifestations of PM in a Korean tertiary hospital and identified the role of transbronchial lung biopsy (TBLB) in diagnosing PM in patients admitted to an intensive care unit.
Methods
The medical records of adult patients (aged 16 years and older) who met the criteria for proven or probable PM in a Korean tertiary hospital were retrospectively reviewed from January 2003 to December 2013. The clinical features, computed tomographic findings, diagnostic methods, treatment, and outcomes in patients with PM were evaluated.
Results
Of the nine patients, four were male. The median age was 64 years (range, 12 to 73 years). PM was proven and probable in seven and two cases, respectively. Computed tomography findings of PM were unilateral involvement in eight cases (89%), consolidation in eight (89%), ground glass opacity in four (44%), and reverse halo sign in one (11%). Six of nine cases (67%) were diagnosed as PM from TBLB via portable bronchoscopy. There were no complications after TBLB. Mortality rate was 56% (five of nine cases).
Conclusions
TBLB can be an easy and useful technique for diagnosing PM in the intensive care unit.

Case Report

Infection
Disseminated Gastrointestinal Mucormycosis in Immunocompromised Disease: Tae Sun Ha, Chi-Min Park, Jeong Hoon Yang, Yang Hyun Cho, Chi Ryang Chung, Kyeongman Jeon, Gee Young Suh; Korean J Crit Care Med. 2015;30(4):323-328. Published online November 30, 2015; DOI: https://doi.org/10.4266/kjccm.2015.30.4.323

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Abstract PDF

Mucormycosis is an uncommon opportunistic fungal infection mostly affecting immunocompromised patients and gastrointestinal mucormycosis is a rare and life-threatening. We describe a 31-year-old man with a history of idiopathic cyclic neutropenia who developed perforations of the stomach and intestine and intra-abdominal bleeding due to disseminated gastrointestinal mucormycosis after the initial operation.

Citations

Citations to this article as recorded by

A Fatal Case of Disseminated Intestinal Mucormycosis in a Patient with Vibrio Sepsis
Seungwoo Chung, Hyun-Jung Sung, Jong Won Chang, Ile Hur, Ho Cheol Kim
Journal of Acute Care Surgery.2021; 11(3): 133. CrossRef
Gastric Mucormycosis Followed by Traumatic Cardiac Rupture in an Immunocompetent Patient
Sang Won Lee, Hyun Seok Lee
The Korean Journal of Gastroenterology.2016; 68(2): 99. CrossRef

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