P256 A rare case of co-infection with Nigrospora oryzae with mucormycosis in an immunocompromised post-COVID patient

Abstract Poster session 2, September 22, 2022, 12:30 PM - 1:30 PM Objective A rare case of co-infection of Nigrospora oryzae with mucormycosis in an immunocompromised post-COVID patient. Methods A 41-year-old male diabetic patient, with sub-optimal glycemic control, contracted COVID-19 infection and was managed with high-dose steroids. A month after recovery from COVID-19 infection, he developed severe headache with sudden onset right-sided facial swelling. A contrast-enhanced magnetic resonance imaging was done which was suggestive of infective/inflammatory rhinosinusitis with intracranial extension with a possibility of fungal etiology. Functional endoscopic sinus surgery was performed and tissue was sent for microbiological processing. On KOH mount, broad pauciseptate fungal hyphae were seen. Fungal growth was obtained on SDA at 25°C and 37°C within 4 days of inoculation. It was confirmed as Rhizopus arrhizus both phenotypically as well as by MALDI-TOF. Patient was put on antifungal therapy in form of Inj liposomal Amphotericin B 500 mg/d. However, patient had persistent headache, vomiting, and low-grade fever post-procedure. A repeat CE-MRI was performed which was suggestive of necrotic brain tumor/abscess and was planned for frontal lobe abscess drainage. Pus was inoculated on routine mycological media. On KOH mount, broad pauciseptate hyphae along with narrow septate hyphae were seen. Fungal growth was obtained on SDA at 25°C within 5 days of inoculation, which on LPCB were identified as Nigrospora spp. The identity of the isolate was confirmed by Next generation sequencing as Nigrospora oryzae. Post-2 weeks of treatment and strict glycemic control, patient started improving. The headache and swelling subsided. He was further started on oral hypoglycemic agents and discharged and was asked to follow up after a month. Results COVID-19 epidemic that emerged by the end of 2019 has been associated with a huge number of deaths globally. Acute invasive fungal rhino-sinusitis is a potentially fatal infection in immune-compromised patients post COVID-19. Various studies reveal that invasive fungal infections have been the leading cause of death in 25%-73.7% of patients. Among these invasive fungal infections, Mucor spp. were detected in 77.8% patient, Aspergillus fumigatus in 30.6% while 8.3% showed mixed infection with both the fungi. Along with the established pathogenicity of Mucorales in causing invasive fungal infection, other fungal co-infections are also being observed. These invasive fungal infections in an immune-compromised host carry a high mortality and morbidity rate (18%-80%). Therefore, early diagnosis, followed by aggressive medical care, surgical debridement, and control of underlying diseases is of utmost importance. Conclusion Acute invasive fungal rhinosinusitis saw a spurt in incidence during the widespread COVID-19 pandemic. Diagnosis of invasive fungal infection is based on the clinical setting and characteristic presentation, supported by radiological and microbiological evidence. Prompt diagnosis and treatment are the need of the hour.