A case of severe pneumonia caused by COVID-19 and secondary Lichtheimia ramosa infection in a diabetic patient undergoing hemodialysis

Purpose Mucormycosis caused by Lichtheimia ramosa (L. ramosa) is an opportunistic fungal infection that occurs more frequently in immunocompromised individuals. Case Presentation: We present the case of a 62-year-old man with diabetes mellitus, hypertension, and chronic kidney disease on regular hemodialysis. He was hospitalized for coronavirus disease 2019 (COVID-19) pneumonia and treated with broad-spectrum antibiotics and corticosteroids. Forty days later, the patient developed worsening hypoxemia requiring intensive care unit (ICU) transfer. Bronchoalveolar lavage fluid (BALF) culture was used to grow a fungal isolate, which was later confirmed as L. ramosa by next-generation sequencing (NGS). Despite antifungal therapy with liposomal amphotericin B, the patient progressed to multiorgan failure and died. Conclusion This study reports a case of severe pneumonia caused by secondary L. ramosa infection following COVID-19. The patient, who had comorbid diabetes mellitus and maintenance hemodialysis, presented with relatively rare clinical manifestations. NGS plays a pivotal role in rapidly identifying this secondary fungal infection, confirming the clinical utility of this technology in diagnosing rare opportunistic fungal infections in COVID-19 patients.