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The first report of rhinosinusitis by Rhizopus delemar in a patient with severe COVID-19 in Iran: a case report

Summary

A 63-year-old man hospitalized with COVID-19 developed a serious fungal sinus infection caused by a rare mold called Rhizopus delemar. Despite surgery to remove infected tissue and treatment with antifungal medication amphotericin B, the infection spread and the patient died after five weeks. This was the first documented case of this particular mold causing sinus infection in a COVID-19 patient in Iran, highlighting how severe fungal infections can occur as dangerous complications of COVID-19.

Background

Mucormycosis is a severe and fatal fungal infection that affects immunocompromised individuals, including those with COVID-19. The prevalence of fungal co-infections increased during the COVID-19 pandemic due to widespread corticosteroid use and prolonged hospitalization. Rhizopus delemar is a rare opportunistic pathogen causing invasive mucormycosis.

Objective

To present the first documented case of rhinosinusitis mucormycosis caused by Rhizopus delemar in a patient with severe COVID-19 infection in Iran. The case highlights the diagnostic challenges and treatment difficulties associated with this emerging pathogen.

Results

Direct microscopy revealed broad aseptate hyphae characteristic of mucormycosis. Isolation and cultivation showed greyish brown colonies. Molecular sequencing identified the pathogen as Rhizopus delemar through ITS and LSU sequence homology. Despite treatment with amphotericin B (50 mg/day) and sinus debridement surgery, the patient died after 35 days of hospitalization.

Conclusion

This is the first documented case of Rhizopus delemar rhinosinusitis mucormycosis in a COVID-19 patient in Iran. Rapid diagnosis through molecular methods and exploration of alternative antifungal treatments beyond amphotericin B may be crucial for managing R. delemar infections. The high mortality rate highlights the severity of mucormycosis in critically ill COVID-19 patients.
  • Published in:Journal of Medical Case Reports,
  • Study Type:Case Report,
  • Source: PMID: 39497105, DOI: 10.1186/s13256-024-04873-w
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