A 53-year-old male patient presented with fever, cough, and a saturation of 92% on room air; a throat swab demonstrated coronavirus disease 2019 (COVID-19). The patient was admitted to the intensive care unit. He required non-invasive ventilatory assistance for approximately ten days and was later switched to a face mask with an oxygen requirement of two liters per minute. During his one-month hospital stay, he was given ceftriaxone, remdesivir, hydrocortisone, and azithromycin. A CT chest scan revealed several patchy areas of interstitial thickening with ground glass opacities in the subpleural and peribronchial regions of the bilateral lung fields, as well as air space densities and fibrosis, particularly in the posterior aspect and basal segments of bilateral lung fields. With 94% saturation, the patient stayed home for 15 days with nasal prongs assistance. At home, the room air saturation was 86– 88%. After 15 days, the patient complained of significant left-side chest discomfort and was hospitalized. A chest CT revealed a left-sided pneumothorax. Intercostal drainage was performed immediately, and the patient was intubated on the same day. After 15 days in that hospital, he was referred to the authors’ hospital because of an inability to wean from ventilatory support and renal failure necessitating dialysis. He had abnormal blood sugar levels following the covid infection. After three days, the patient presented with significant upper gastrointestinal (GI) bleeding and hypotension, necessitating vasopressors. Three units of packed red blood cells (PRBCs) and omeprazole were administered. Emergency angiography revealed active extravasation from the distal splenic artery, which was embolized with metallic micro coils. After stabilization, the patient underwent esophagogastroduodenoscopy (EGD), which revealed a large ulcer with a clot in the fundus. A triple-phase computed tomography of the abdomen showed no obvious contrast extravasation or pseudoaneurysm, with a non-enhancing stomach wall at the fundus, adherent to the left hemidiaphragm, and gastro pleural connection with left-sided hydropneumothorax (Fig. 1). Bile and necrotic debris were emerging from the intercostal tube. The fluid sample was sent for a bacterial and fungal culture. The following observations were made on emergency exploration. Blood clots (500 g) were observed in the left subdiaphragmatic region. The proximal stomach was necrotic, which included the cardia, fundus, and proximal section of the greater curvature (Fig. 2). A diaphragmatic defect with a diameter of approximately 5 cm is evident. The pancreas was plastered to the posterior wall of the stomach. A proximal gastrectomy, tube esophagostomy, vented gastrostomy, and feeding jejunostomy were necessary. Mucormycosis was demonstrated by pathology (Figs. 3, 4). Liposomal amphotericin B was administered to the patient. The patient later experienced severe respiratory failure because of pneumonia. Bloodstream cultures revealed Klebsiella pneumoniae. Unfortunately, the patient passed away on the tenth postoperative day.

An 82-year-old male patient with a history of a COVID-19 infection (two weeks earlier) arrived with upper stomach pain and two episodes of severe hematemesis linked to dizziness and syncope. The patient was admitted to the intensive care unit, and there was no hemodynamic instability at the time of admission. He was started on a pantoprazole infusion and received two PRBC transfusions. The patient underwent an emergency Esophagogastroduodenoscopy that revealed a large white-based ulcer with many sloughs along the larger curvature of the body (Fig. 5), and biopsies were taken. Histopathology revealed mucormycosis (Fig. 6). The contrast- enhanced chest and abdomen CT revealed ground-glass attenuation in the peripheral parts of the lower lobes of both lungs, mild wall thickening along the greater curvature of the stomach, and a hypodense non-enhancing mottled air-containing slough-like lesion adhered to the gastric wall along the greater curvature (Fig. 7). The patient was given a cumulative dose of 2.5 gm of intravenous liposomal Amphotericin B before being transferred to oral isavuconazole 200 mg once per day for two weeks. The patient was eating normally, and there were no further episodes of hematemesis. After four weeks, the patient was advised to come to the out patient department (OPD) for a repeat EGD.