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Quantitative B and T cell abnormalities in four patients presenting with mucormycosis and prior asymptomatic COVID-19 infection
  1. Charuta Mandke1,
  2. Rohit Divekar2,
  3. Vandana Pradhan3 and
  4. Shitij Arora4
  1. 1Department of Ophthalmology, Hinduhridaysamrat Balasaheb Thackeray Medical College and Dr Rustom Narsi Cooper Municipal General Hospital, Mumbai, Maharashtra, India
  2. 2Division of Allergic Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
  3. 3Department of Clinical and Experimental Immunology, Indian Council of Medical Research, Mumbai, Maharashtra, India
  4. 4Department of Internal Medicine, Division of Hospital Medicine, Montefiore Hospital and Medical Center, Bronx, New York, USA
  1. Correspondence to Dr Shitij Arora; sharora{at}


India saw an unprecedented and rapid rise of invasive coronavirus-associated mucormycosis (CAM) during the delta COVID-19 surge. There is little known about the pathophysiology and if there is a direct causation between the COVID-19 infection and invasive CAM. While the traditional risk factors such as uncontrolled diabetes and other immunocompromising conditions are recognised, there could be several COVID-19-induced phenomena that may predispose the patients to develop CAM and are yet unrecognised. It has been proposed that prior severe COVID-19 is associated with invasive CAM. This could be due to the increased use of immunomodulators or the direct effects of the COVID-19 infection. We report four patients with CAM during the delta surge who did not have prior known COVID-19 infection but on subsequent testing had positive antibodies suggesting past asymptomatic infection. We report the quantitative abnormalities in lymphocyte subsets in all four patients and report CD19+ B cell lymphopenia and reduced percentage of CD27+ CD45RA+ naïve helper T cells. CAM may occur in patients after asymptomatic COVID-19 infection, in the absence of systemic corticosteroid and immunomodulator use, and may reflect underlying immune abnormalities possibly attributable to or unmasked by prior COVID-19 infection.

  • COVID-19
  • Immunology
  • Infectious diseases
  • Ophthalmology

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  • Contributors The patient was under the care of and treated by CM. Immunological investigations were performed by VP, as advised by RD and SA. The case series was written by CM and SA.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.