Black fungus of intestine: Novel complication diagnosed in Covid patients in Delhi

A novel complication of mucormycosis or black fungus has been detected in a city hospital here in which the fungal infection infected the lower intestine of two patients, including a 56-year-old who lost three family members, including his wife, due to Covid.

Both the patients, including one aged 68 years, are being treated at Delhi’s Sir Ganga Ram Hospital for more than a week. “It is observed for the first time that the black fungus infected the lower intestine and even made a hole in it,” said Ganga Ram Hospital authorities.

Kumar (name changed on request), a resident of Delhi, had barely completed the last rites of his wife when he experienced pain in his abdomen. He had been tested positive for Covid along with his wife and had been experiencing mild covid symptoms initially.

The patient’s abdominal pain was considered gastritis or stress-related and self-medication for acidity was taken which delayed proper treatment by three days, said authorities at the Sir Ganga Ram Hospital.

Kumar was evaluated in Covid emergency of Ganga Ram Hospital by Dr Ushast Dhir, senior consultant in department of Surgical Gastroenterology and Liver Transplantation.

“The CT scan revealed Kumar’s small intestine (jejunum) had been perforated. His Covid disease also had worsened by now requiring ventilator support. The patient was admitted and taken up urgently for surgery.”

According to Dr Dhir, “Ulceration of Jejunam (first part of small intestine) in the patient raised my suspicion of fungal disease and patient was immediately started on anti-fungal treatment. We sent the portion of removed intestine for biopsy.”

Another patient, Ijaz’s family was relieved to know that their father had recovered from Covid. But he started having mild abdominal pain. Ijaz ((name changed on request)) was a diabetic and had received steroids for treatment of Covid. The patient had no associated fever and pain was very mild.

His clinical examination also did not show any signs of intestinal perforation.Still, acting on suspicion, Dr Piyush Ranjan, senior consultant of Medical Gastroenterology at the Sir Ganga Ram Hospital, instructed for an urgent CT to be conducted for the patient.

“The CT scan revealed small intestinal perforation similar to the first patient,” the hospital authorities said.

“The biopsy confirmed our worst fear of mucormycosis of small intestine in both patients. Both these patients had Covid and had diabetes but only one of them had received steroids.”

Mucormycosis most commonly involves Rhino-orbital-cerebral system or the lungs. Intestinal or GI mucormycosis is a very rare disease and most commonly involves the stomach or the large intestine.

“These patients in majority are immune-compromised. A majority of gastro-intestinal mucormycosis is seen in organ transplant recipients. The cases treated at Sir Ganga Ram Hospital were unique as as they had covid and small intestine (instead of stomach or colon) was involved in both,” hospital authorities said

“GI mucormycosis is rare and the patient presents with vague abdominal symptoms. In recent times history of Covid exposure along with treatment with steroids should warrant an early CT scan of abdomen,” they added.