At Delhi hospital, two cases of black fungus in small intestine among Covid patients

While both patients had Covid and diabetes, only one had received steroids during treatment, doctors at Sir Ganga Ram Hospital said.

Doctors at Delhi’s Sir Ganga Ram Hospital have reported two cases of rare mucormycosis of the small intestine among Covid patients admitted there.

The hospital has been seeing among the highest number of mucormycosis or black fungus cases in Delhi, amidst an uptick in the number of cases of the rare disease in the city.

Hospitals have been reporting cases of rhino-orbital mucormycosis, which has been manifesting in facial swelling and numbness, pain in the eye, blurry vision or loss of vision, nasal blockage, formation of black crust in the nose or black discharge from the nose, and blackening inside the mouth.

The cases of gastro-intestinal mucormycosis have been seen in a 56-year-old and a 68-year-old, both of whom had Covid and diabetes, and both of whom were found to have intestinal perforation after undergoing CT scans. According to the hospital, the 56-year-old patient had not been administered steroids as part of Covid treatment before the diagnosis.

“The patient had tested positive with the rest of his family, and three of them, including his wife, died. He was experiencing mild symptoms but started experiencing mild abdominal discomfort, which was regarded as gas and acidity by his family and was treated with local medication and home remedies. By the time he came in after three days, his Covid symptoms had become more severe and he  had greater abdominal discomfort, which raised our suspicions and we got a CT scan done, which showed that his small intestine had perforated. In the second case, the 68-year-old had recovered from Covid and had been given steroids during treatment. His abdominal pain was very mild which may have been overlooked, but we had a high index of suspicion because we had seen the other patient, and got a CT scan done, which also revealed a small intestinal perforation,” said Dr Ushast Dhir, senior consultant in the department of Surgical Gastroenterology and Liver Transplantation at the hospital.

He said that biopsies revealed mucormycosis of the small intestine of both cases.

He noted that the cases are unique in several ways. “One of the patients had not received steroids at all as part of the treatment regimen, making us think whether Covid along with diabetes is itself a risk factor for intestinal mucormycosis. Second, gastro-intestinal mucormycosis is extremely rare anyway — it is mostly seen in transplant recipients and I have never seen it in any other case in my experience — and even then it usually affects the stomach or large intestine. Third, the signs and symptoms were very mild,” he said.

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