Pulmonary Artery Pseudoaneurysm in COVID-19-Associated Pulmonary Mucormycosis: Case Series and Systematic Review of the Literature

Definition, diagnosis, and management of COVID-19-associated pulmonary mucormycosis: Delphi consensus statement from the Fungal Infection Study Forum and Academy of Pulmonary Sciences, India

“… 29 The presence of brownish or black sputum and haemoptysis in a patient with COVID-19, particularly in the presence of risk factors (as mentioned earlier), should trigger investigations for CAPM. 30 Other suggestive features include chest pain; fever despite antibiotic therapy for at least 48 h; worsening or productive cough; cavity; or worsening alveolar shadows on a chest x-ray in the appropriate setting (eg, a patient with uncontrolled diabetes).…”

“… 40 , 41 By contrast, CAPM most often occurs in patients with diabetes following COVID-19 and thus resembles pulmonary mucormycosis occurring in patients with diabetes rather than haematological malignancies. 30 , 42 , 43 , 44 The presentation in CAPM could be indolent, 30 , 45 and not as aggressive as in haematological malignancies. Additionally, most patients with CAPM present relatively late (usually >7 days after the onset of COVID-19), and the halo sign is not commonly seen at the time of diagnosis.…”

“… 48 , 49 , 50 , 51 , 52 Bronchoscopy and bronchoalveolar lavage with 60 mL of saline has been safely done even in patients with severe acute respiratory distress syndrome due to COVID-19 (median fractional concentration of oxygen of inspired air is 0·8 and positive end-expiratory pressure of 10 cm of water). 48 The median time of occurrence of CAPM following COVID-19 ranges from 2 to 3 weeks 6 , 30 and the majority of patients are unlikely to transmit SARS-CoV-2 during this period. Preliminary data suggest that the use of bronchoscopy is safe in patients with CAPM.…”

“…Mycotic aneurysms encountered in CAPM have the potential to cause fatal or severe haemoptysis. 22 , 24 , 30 Hence, a cautious approach is required when carrying out flexible bronchoscopy, bronchoalveolar lavage, or biopsies in patients with massive haemoptysis or mycotic aneurysms. Notably, the bronchoscopy unit should be equipped to handle emergencies, such as severe bleeding following diagnostic bronchoscopies.…”

COVID-19-Associated Pulmonary Mucormycosis: An Underdiagnosed Entity with High Mortality

“…We read the article by Watanabe et al with interest wherein the authors performed a systematic review of literature on COVID-19-associated mucormycosis (CAM) and estimated the pooled mortality at 29% [1]. Unfortunately, the authors have missed several peer-reviewed articles published before January 20, 2022 [2][3][4][5]. These studies had a larger proportion of pulmonary mucormycosis [2,4], reported higher mortality (73-88%) [2,5], and including them might have yielded a different result.…”