Bilateral renal mucormycosis following COVID-19 infection: A therapeutic challenge.

Clinical Nephrology. Case Studies Pub Date : 2022-11-24 eCollection Date: 2022-01-01 DOI:10.5414/CNCS110874
Rajasekaran Kishor Kumar, Rajeev A Annigeri, Ram Gopalakrishnan, Sunil S Kaveripattu, Nitesh Jain
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Abstract

India witnessed an epidemic of mucormycosis during the second wave of the COVID-19 pandemic. Renal mucormycosis has been reported rarely, mostly from India, but only 2 cases have been reported following COVID-19 infection to date. We report a case of mucormycosis predominantly affecting kidneys in a young and previously healthy male following COVID-19 pneumonia, for which he had received corticosteroid, remdesivir, and tocilizumab. He presented with hematuria, progressive oliguria, and severe acute kidney injury (AKI) requiring dialysis. The diagnosis was made on kidney biopsy and contrast-enhanced CT (CECT) showed segmental and subsegmental renal artery pseudoaneurysms with distal occlusion of both kidneys. He underwent bilateral nephrectomy and received high-dose amphotericin (AMB) and posaconazole. He developed cardiac arrhythmia and pulmonary edema attributed to AMB-related cardiotoxicity after a cumulative ABM dose of 2,450 mg. This is the first case report describing the survival of a patient with bilateral renal mucormycosis following COVID-19 infection. Our case report highlights the importance of considering mucormycosis in a patient with post-COVID-19 AKI to make an early diagnosis and aggressive management comprising of surgical debridement and high-dose AMB to improve survival.

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感染 COVID-19 后的双侧肾脏粘液瘤病:治疗难题
在 COVID-19 第二波流行期间,印度出现了粘孢子虫病流行。肾脏粘孢子菌病鲜有报道,主要来自印度,但迄今为止仅有两例感染 COVID-19 后出现肾脏粘孢子菌病的报道。我们报告了一例主要累及肾脏的粘液瘤病病例,患者是一名年轻男性,之前身体健康,在感染 COVID-19 肺炎后曾接受过皮质类固醇、雷米替韦和妥西珠单抗治疗。他出现血尿、进行性少尿和严重急性肾损伤(AKI),需要进行透析。经肾脏活检确诊,对比增强 CT(CECT)显示双肾节段性和节段下肾动脉假性动脉瘤,远端闭塞。他接受了双侧肾切除术,并接受了大剂量两性霉素(AMB)和泊沙康唑治疗。在累计服用 2,450 毫克 ABM 后,他出现了心律失常和肺水肿,这归因于 AMB 相关的心脏毒性。这是第一份描述感染 COVID-19 后双侧肾脏粘液瘤病患者存活的病例报告。我们的病例报告强调了在 COVID-19 感染后出现 AKI 的患者中考虑粘液瘤病的重要性,以便及早诊断和积极治疗,包括手术清创和大剂量 AMB 以提高存活率。
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