A rare case of knee joint mucormycosis with pathological fracture after COVID-19 infection

Mucormycosis is a fungal infection that generally occurs in patients with some degree of immunosuppression, such as patients with malignancies, diabetes, HIV infection, or patients who require the administration of immunosuppressive drugs.

The final diagnosis is established by collecting some tissue from the infectious process and isolating the fungus using lab cultures.

The treatment of mucormycosis is complex and consists of trying to reduce risk factors, rigorous surgical debridement, and specific antifungal treatment.

We present the case of a 54-year-old male patient with a background of SARS-COV2 infection (moderate form), that started 3 months prior to presentation to our hospital, initially treated at home.

The patient presented to the Orthopaedics Department of the University Emergency Hospital of Bucharest with pain and total functional impotence in his left knee as a result of a trauma that occurred about 2 months before the presentation to the hospital, at that moment with progressive worsening of the symptoms. Clinical and imaging examination established the diagnosis of pathological supra-intercondylar fracture of the left femur.

The purpose of this case report is to present the risk of infection with an opportunistic agent as a result of immunosuppression induced by COVID-19 or its treatment with immunosuppressive agents necessary to combat the inflammatory process. The patient presented with a moderate form of COVID-19 treated at home with nonsteroidal anti-inflammatory drugs and antibiotics to prevent a bacterial superinfection.

Mucormycosis remained a challenging situation for the physician, regardless of his medical specialty, both in terms of diagnosis and treatment. In this case, COVID-19 is one of the risk factors that contributed to the appearance of mucormycosis.