The Post-COVID Deadly Trio of Mucormycosis, Invasive Aspergillosis, and Acute Kidney Injury: Physician’s Nightmare and Management Dilemma in Resource Constraint Setting

Abstract Invasive fungal infections are common in clinical settings of diabetes mellitus, immunosuppression, malignancy, and organ and tissue transplantation. Fungal infections were reported increasingly during the COVID-19 waves, with many cases ending in fatality. The reason for such increased incidence is deemed to be a mix of factors, with high steroid use being a major contributor. We present a patient with mixed mucormycosis and invasive aspergillus infection of paranasal sinuses, postrecovery from moderate COVID-19 disease. The patient developed acute kidney injury after starting liposomal amphotericin B, and it had to be stopped. The dilemma was “What next?” since the drug of choice could not be continued. The patient was managed with surgical debridement, intense surveillance, and alternate antifungals. The outcome was encouraging. We discuss the dynamics of polyene-induced renal function impairment, the possibility of the use of alternate antifungals and their basis, and the importance of a combination approach as a recipe for success.