Horiguchi Tomoya, Tsukamoto Tetsuya, Toyama Yoko, Sasaki Toshiharu, Nakamura Tomoyuki, Sakurai Aki, Kuriyama Naohide, Komatsu Satoshi, Shigeyasu Yoshiko, Ina Takuma, Sakurai Eiko, Nakajima Noriko, Tsuchimori Arisa, Yamada Seiji, Suzuki Tadaki, Imaizumi Kazuyoshi
Department of Respiratory Medicine Fujita Health University, School of Medicine Toyoake Japan.
Department of Diagnostic Pathology Fujita Health University, School of Medicine Toyoake Japan.
Respirol Case Rep. 2022 Feb 13;10(3):e0912. doi: 10.1002/rcr2.912. eCollection 2022 Mar.
Secondary fungal infections are a critical problem that accompany immunosuppressive therapy for severe coronavirus disease 2019 (COVID-19). We report a fatal case of COVID-19 with disseminated mucormycosis diagnosed during autopsy. A 58-year-old man with diabetes was hospitalized for severe COVID-19 and treated with remdesivir, systemic steroids and tocilizumab. Following treatment, he was provided extracorporeal membrane oxygenation support. However, he died of multiple organ failure accompanied by pulmonary and kidney infarction, as revealed by computed tomography. Autopsy revealed that the infarction was caused by thromboangiitis due to mucormycosis in the brain, lungs, heart, liver and kidneys. Therefore, the diagnosis of disseminated mucormycosis was established. Disseminated mucormycosis is a rare complication of COVID-19. Although its early diagnosis is difficult, the disease progresses rapidly. Hence, we propose that immunosuppressive treatment for COVID-19 should be administered with caution considering the risk of developing severe opportunistic infections, such as mucormycosis.
继发性真菌感染是重症2019冠状病毒病（COVID-19）免疫抑制治疗伴随的一个关键问题。我们报告一例在尸检时诊断为播散性毛霉病的COVID-19死亡病例。一名58岁的糖尿病男性因重症COVID-19住院，接受了瑞德西韦、全身用类固醇和托珠单抗治疗。治疗后，他接受了体外膜肺氧合支持。然而，计算机断层扫描显示，他死于多器官衰竭，并伴有肺和肾梗死。尸检显示，梗死是由脑、肺、心脏、肝脏和肾脏的毛霉病引起的血栓性血管炎所致。因此，确诊为播散性毛霉病。播散性毛霉病是COVID-19的一种罕见并发症。虽然其早期诊断困难，但疾病进展迅速。因此，我们建议，考虑到发生严重机会性感染（如毛霉病）的风险，对COVID-19的免疫抑制治疗应谨慎使用。
