Exophiala dermatitidis, ‘the real black fungus’ fungemia in a patient with COVID-19

• Published in: IDCases Vol. 27; p. e01428
• Main Authors: Tzar, Mohd Nizam, Meor Jamaludin, Wan Husna Barakah, Abdul Wahab, Asrul, Ding, Chuan Hun
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01.01.2022; Elsevier
• Subjects: Antifungal; Case Report; Coronavirus; COVID-19; Dematiaceous; Malaysia; Mycosis; COVID-19; Dematiaceous; Malaysia; Coronavirus; Antifungal; Mycosis
• ISSN: 2214-2509; 2214-2509
• DOI: 10.1016/j.idcr.2022.e01428

•This case represents the true black fungus infection in a patient with COVID-19.•The first case of Exophiala dermatitidis fungemia and COVID-19 co-infection.•Very low MICs did not necessarily translate into treatment success.•Removal of CVC and voriconazole therapy produced the best survival outcome. The second wave of the COVID-19 pandemic in India had brought with it a surge of ‘black fungus’ co-infection, which is a misnomer for mucormycosis. The present case illustrates the ‘real black fungus’ infection in a 50-year old male patient with COVID-19 pneumonia, who otherwise had no significant previous medical history. He was admitted on day 8 of COVID-19 illness and was intubated due to persistently low oxygen saturation. Blood cultures were positive for flask-shaped dematiaceous budding yeasts with pseudohyphae formation, which grew as brown-black fuzzy colonies on Sabouraud dextrose agar. The isolate was identified as Exophiala dermatitidis based on phenotypic characterization. Despite antifungal therapy with amphotericin B and itraconazole, the patient deteriorated rapidly and succumbed to acute respiratory distress syndrome and multiorgan failure. A review of reported cases of Exophiala dermatitidis fungemia over the last 5-years is discussed.