COVID-19-associated disseminated mucormycosis: An autopsy case report

Figure 1 Imaging and histological findings during treatment. A: Computed tomography (CT) images of acute respiratory distress syndrome (ARDS). Left image: CT image at the time of ARDS diagnosis. Right image: CT image after 38 d; B: The necrotic ileostoma caused by the mucormycosis can be seen in this image; C: Surgical findings at the stomal reconstruction; D and E; Presence of thrombus with Mucorales in the mesenteric vessels of the necrotic ileostoma. H&E staining; magnification × 200 (D), Grocott staining; magnification × 200 (E). Bar: 200 μm.

Figure 2 Autopsy findings of the Mucorales infection. A: The image shows the necrotic stoma, skin, and abdominal wall; B: The necrotic abdominal organs are seen in this image. A pathologist held the intestine on the oral side of the stoma; C: Dorsal view of the incised common iliac vein. The thrombus can be seen in the common iliac vein (indicated by arrows).

Figure 3 Histopathological findings of the Mucorales infection in the organs and thrombus. A and B: Presence of Mucorales in the thrombus; H&E staining; magnification × 100 (A), × 200 (B); C: Macroscopic image showing partial necrosis of the liver; D: Hepatic infarction caused by the thrombus including Mucorales; H&E staining; magnification × 200; E: The proliferative/organizing phase of diffuse alveolar damage of the left lung. Restoration of type II pneumocytes and proliferation of myofibroblasts are partially shown. H&E staining; magnification × 40; F: Cytomegalovirus infection. Cytomegalovirus-infected cells are indicated by black arrows. H&E staining; magnification × 200. Bar in the autopsy images: 2 cm; Bar in the microscopic images: 200 μm.

Figure 4 The autopsy diagnosis. A: The image shows the organs and part of the Mucorales infection. The gray areas indicate areas infected with Mucorales. The resected ascending colon is transparent in the drawing; B: A flowchart of the autopsy diagnosis.