In what is thought to be a first-of-its-kind case, the city’s Sir Ganga Ram Hospital (SGRH) reported a white fungus infection which caused severe ulceration and gangrene of the intestine with multifocal perforations in the food pipe, the small and large bowel in a Covid-19 patient.

A 49-year-old woman was admitted to the SGRH on May 13 with complaints of severe abdominal pain, vomiting and constipation. A CT scan of theabdomen revealed free air and moderate amount of free fluid in theabdominal cavity suggestive of an intestinal perforation.

Doctors placed a tube inside the abdomen and drained about one litreof bile stained pus. An emergency surgery was conducted the next day by a team of surgeons led by Dr Samiran Nundy of the Department of Surgical Gastroenterology and Liver Transplantation

Dr Nundy said that the perforation in the lower end of the food pipe was revealed after the surgery.

“A part of the small intestine had developed gangrene and sloughed off and she had multiple thinned-out patches in the wall of the colon with one small leak.  The perforations were closed and the gangrenous segment was resected in adifficult surgery lasting for four hours after which a piece of the intestinewas sent for biopsy,” he said.

“The biopsy of the intestinal segment showed the presence of severeulceration of the intestinal wall with resultant perforation and necrosis caused by invasive Candida pseudohyphae - the white fungus.

She was immediately started on anti-fungals and showed remarkableimprovement,” said Dr (Prof) Anil Arora, Chairman, Institute of Liver, Gastroenterology and Pancreaticobiliary Sciences.

However, five days later, she had to undergo a second surgery for asmall leak from the anastomotic site. She is currently recovering from it, said Dr Aurobindo of the Department of Liver Transplantation and GI Surgery.

Dr Arora added: “The Covid-19 virus has been known to affect the lungs and upper respiratory tract. Infection of the intestine by the black fungus (Mucormycosis) secondary to steroid use has been recently reported but white fungus (Candida) causing severe ulceration and gangrene of the intestine presenting with multifocal perforations in the esophagus, small bowel and large bowel in the setting of Covid-19 infection has not been reported in literature to the best of our knowledge.”

 As the exact mechanism is unknown, the probable explanation involves an unholy combination of three states causing immune suppression: A malignancy (carcinoma breast), recent chemotherapy and a superimposed Covid-19 infection, he said.

“All three factors conspired together in her case bringing down theimmune system to dismally low levels resulting in the turning of a normalinhabitant of the intestine called Candida into a monstrous invasive formresulting in multifocal intestinal perforations with resultant shockand septicemia,” he added.