Two patients diagnosed with black fungus in small intestine in Delhi hospital

Raising concerns of medical experts, two patients have been diagnosed with mucormycosis or black fungus in the small intestine in a major hospital here. Both of the patients had tested positive for Covid-19 and were diagnosed with Mucormycosis in the small intestine. The doctors have said this as "rare" cases.

Mucormycosis, most commonly involves the rhino-orbital-cerebral system or the lungs. Intestinal or GI mucormycosis is a very "rare disease", and most commonly involves the stomach or large intestine, according to doctors at the Sir Ganga Ram Hospital.

A 56-year-old Delhi resident, who had lost three of his family members including his wife to the pandemic, had barely completed the last rites of his wife when he experienced pain in his abdomen. He had tested positive for coronavirus along with his wife and had been experiencing mild symptoms initially, the hospital said in a statement.

He was finally evaluated in the Covid emergency of Sir Ganga Ram Hospital by Dr Ushast Dhir, senior consultant in the department of Surgical Gastroenterology and Liver Transplantation, it said.

The CT scan revealed that the first part of his small intestine or jejunum had perforated. His Covid ailment also had worsened by now requiring ventilator support. The patient was admitted and taken up urgently for surgery, hospital authorities said.

"Ulceration of jejunum in the patient raised my suspicion of fungal disease, and the patient was immediately started on antifungal treatment. We sent the portion of the removed intestine for biopsy," the doctor said.

The second patient, a 68-yearold man, who was happy to know that his father had recovered from Covid-19, started having mild abdominal pain. The patient had no associated fever and pain was very mild. His clinical examination also did not show any signs of intestinal perforation, the statement said.

But, a high index of suspicion led Dr Piyush Ranjan, senior consultant of medical gastroenterology at Sir Ganga Ram Hospital, to get an urgent CT scan of the patient. The CT scan revealed small intestinal perforation similar to the first one, it added.

"The biopsy confirmed our worst fear of mucormycosis of the small intestine in both patients. Both these patients had Covid and had diabetes, but only one of them had received steroids," the hospital said in the statement.

Both these patients were operated by Dhir, who revealed that these patients had "similar intraoperative findings" where jejunum had out-pouchings called diverticula and these diverticula had perforated along with surrounding ulceration, it said.

"These patients, in majority, are immune-compromised. Majority of gastro-intestinal mucormycosis is seen in organ transplant recipients. The cases treated at Sir Ganga Ram Hospital were unique as they had Covid and small intestine (instead of stomach/colon) was involved in both cases," the statement said.