Sir Ganga Ram Hospital, one of the top hospitals of Delhi, has reported a first-of-its-kind case of white fungus which causes multiple perforations throughout the intestine in a COVID-19 patient, informed doctors on Thursday. White fungus (Candida) causing multifocal perforations in the food pipe, small bowel and large bowel in COVID-19 infection has not been reported in literature to the best of our knowledge, said Dr Anil Arora, Chairman of the Institute of Liver, Gastroenterology and Pancreaticobiliary Sciences at the hospital.
A 49-year-old woman was admitted to the SGRH on May 13 with complaints of severe abdominal pain, vomiting and constipation. She had undergone a mastectomy for breast cancer in December last year and had received chemotherapy till four weeks ago, he said.
A CT scan of the abdomen revealed free air and moderate amount of free fluid in the abdominal cavity suggestive of an intestinal perforation, the hospital said in a statement.
The doctors immediately placed a tube inside the abdomen and drained about one litre of bile-stained pus.
A team of surgeons led by Dr Samiran Nundy of the Department of Surgical Gastroenterology and Liver Transplantation conducted an emergency surgery on the patient the next day.
The surgery revealed perforation in the lower end of the food pipe. A part of the small intestine had developed gangrene and sloughed off, and the patient had multiple thinned out patches in the wall of the colon with one small leak, Dr Nundy said.
Normally the intestine remains in perfect harmony with the fungus called candida. In immunosuppressed states such as diabetes, injudicious use of steroids, overzealous broad-spectrum antibiotics and chemotherapy for an underlying malignancy, there is inward migration of this candida – the white fungus – from the intestinal lumen into the body tissues by disrupting the normal gut barriers.
This is followed by intestinal complications like ulcers, bleeding, gangrene and perforation, followed by transmigration of the candida across the beleaguered gut barrier into blood, culminating in sepsis and multiorgan failure, Dr Arora said.