Khan Nariman, Gutierrez Christina G, Martinez David Villafuerte, Proud Kevin C
UT Health San Antonio, Joe R. and Terry Lozano Long School of Medicine, Department of Internal Medicine, San Antonio, Texas, USA.
University Health System, Pharmacotherapy and Pharmacy Services, San Antonio, Texas, USA.
Arch Clin Cases. 2021 Oct 27;7(3):46-51. doi: 10.22551/2020.28.0703.10172. eCollection 2020.
Hospitalized patients with SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) are at risk for developing secondary fungal infections due to greater incidence of preexisting comorbidities and exposure to iatrogenic factors such as corticosteroid use. We present the case of a 44-year-old Hispanic female discovered unresponsive in her home that was found to have severe hyperglycemia with comorbid COVID-19 (coronavirus disease 2019) associated pneumonia. The patient was intubated and treated with several broad-spectrum antibiotics, remdesivir, and corticosteroids but had little improvement in her clinical status. Bronchoscopy was performed and revealed multiple necrotic lesions in the lungs. Endobronchial biopsy and bronchoalveolar lavage samples revealed pauciseptated hyphae consistent with zygomycetes. The patient was treated with multiple antifungals including voriconazole, micafungin, and amphotericin B. However, despite maximal medical therapy, the patient perished. This case highlights that clinicians must carry a high degree of suspicion and a low threshold to begin treatment for Mucor in diabetics and other immunosuppressed patients.
感染严重急性呼吸综合征冠状病毒2(SARS-CoV-2)的住院患者因既往合并症发生率较高以及接触如使用皮质类固醇等医源性因素,有发生继发性真菌感染的风险。我们报告一例44岁西班牙裔女性病例,在家中被发现无反应,被诊断为患有严重高血糖症并合并2019冠状病毒病(COVID-19)相关肺炎。该患者接受了气管插管,并使用了多种广谱抗生素、瑞德西韦和皮质类固醇进行治疗,但临床状况几乎没有改善。进行了支气管镜检查,发现肺部有多个坏死性病变。支气管内活检和支气管肺泡灌洗样本显示有与接合菌相符的少隔菌丝。该患者接受了包括伏立康唑、米卡芬净和两性霉素B在内的多种抗真菌药物治疗。然而,尽管进行了最大程度的药物治疗,患者仍死亡。该病例强调,临床医生对于糖尿病患者和其他免疫抑制患者发生毛霉感染必须保持高度怀疑并降低启动治疗的阈值。