Rare and unusual follow-up sequelae of COVID-19: Splenic mucormycosis in a renal transplant recipient.

Meshram, Hari Shankar; Kumar, Deepak; Kute, Vivek B

Background Coronavirus disease (COVID-19) has been reported with adverse outcomes in the transplantation communities. Mucormycosis even though a rare infection, has been classically being linked to organ transplantation and is associated with exceptionally high morbidity and mortality. The double infection of mucormycosis in COVID-19 is a lethal combination to be encountered in this pandemic era but is sparsely described in organ transplantation. Case presentation Here we report a young diabetic kidney transplant recipient who acquired severe COVID-19, followed by disseminated mucormycosis. The patient was a health care worker who developed severe COVID-19 for which he received remdesivir, anticoagulation and dexamethasone. There was no immunomodulatory therapy used. His maximum oxygen support was bilevel positive pressure ventilation (Bi-PAP). His sugars were frequently deranged during the stay. He developed secondary sepsis with Klebsiella, followed by non-healing lung consolidation. Later on, he developed pleural effusion and splenic abscess which was detected incidentally. He underwent an emergency splenectomy, the culture of which yielded mucormycosis. He was started with liposomal amphotericin B 5mg/kg was started. The patient deteriorated, and a repeat laparotomy yielded gastric perforation, with pus culture showing mucormycosis. The patient succumbed to death after an extensive long course of hospital stay. Conclusion We conclude that the diagnosis and management of this dual infection in this pandemic era is extremely challenging. The unusual location of mucormycosis complicating the COVID-19 course in our report, calls for a meticulous approach to opportunistic fungal infections in COVID-19 positive organ transplant recipients, especially with diabetes.