Priscila Nakano, BSN, CPNP, MSN
Nurse Practitioner
Baylor College of Medicine Texas Children's Hospital
Houston, Texas
Disclosure information not submitted.
Maria Fatima Westry, MSPAS, PA-C
Instructor, Advance Practice Provider, Associate Director for Texas Children's Hospital- WC APP's
Baylor College of Medicine, Texas Children's Hospital
Houston, Texas, United States
Disclosure information not submitted.
Title: A Rare, Opportunistic Fungal Infection Taking Advantage of a World Wide Pandemic: A Pediatric Case.
Case Report Body:
Introduction: Mucormycosis is a rare and aggressive form of an opportunistic fungal infection known to mainly affect patients with underlying comorbidities that cause dysfunctional immune systems. Since the declaration of the coronavirus 2019 disease (COVID-19) pandemic in March 2020, there have been increasing reports of adult cases of mucormycosis infections following a severe COVID-19 infection in adult patients with underlying comorbidities. We report a case of tracheal mucormycosis in a pediatric patient with newly diagnosed diabetes mellitus and severe case COVID-19.
Description: Here we describe a case of 13-year-old, morbidly obese male with no prior medical history who presented in diabetic ketoacidosis (DKA) and also noted to be SARS-CoV-2 PCR positive. The DKA was treated with insulin and fluid as per hospital evidence-based guidelines. His initial presentation with Kussmaul breathing resolved with the management of his DKA. On day 3 of admission, he developed respiratory distress requiring increase in respiratory support to non-invasive positive pressure ventilation. With his PCR positive SARS-CoV-2, it was believed that his worsening respiratory status was secondary COVID pneumonia. In the following days, his respiratory status seemed to improve. He had a sudden decompensation on day 9 of admission with increased respiratory distress and obstructive breathing pattern and the decision was made to intubate. During multiple direct laryngoscopies, there was a concern for a subglottic obstruction. He was immediately taken to the operating room for emergent tracheostomy during which necrotic tissue was noted in the trachea. Despite an uncomplicated post-tracheostomy course, he had an acute decompensation during which the trache was replaced. The removed trache had dislodged necrotic tissue. Pathology tissue exam revealed rare fungal organisms and abundant mixed bacteria later identified as mucormycosis.
Discussion: This case demonstrates a rare but known complication associated with uncontrolled diabetes mellitus. In the setting of a world-wide pandemic, the distracting factors of a new novel virus can convolute the concurrent involvement of opportunistic infections such as mucormycosis. Delay in recognition of opportunistic infections in critically ill patients may increase morbidity and mortality.