On the question of mechanisms of damage to the endothelium of blood vessels in angioinvasive mucormycosis on the background of diabetes mellitus

The problem of mycoses during the COVID-19 pandemic has acquired particular importance and remains relevant to this day. Between 7 and 14 % of patients with COVID-19 have diabetes as a major comorbidity. The development of mucormycosis in patients with COVID-19 is facilitated by the use of glucocorticosteroid drugs that suppress immunity and increase blood glucose levels, decompensation of diabetes mellitus, endothelial dysfunction, age (>65 years), and arterial hypertension. Two observations of COVID-19-associated mucormycosis in patients with long-term poorly controlled type 2 diabetes mellitus are presented. Morphological examination in both cases revealed aseptal ribbon hyphae of different diameters, branching mainly at right angles. It should be assumed that possible mechanisms for the development of endothelial dysfunction leading to the formation of blood clots are: angiopathic changes as a result of diabetes mellitus, direct cytopathic effect of the SARS-CoV-2 virus, cytokine storm, oxidative stress and waste products of the fungus. Thrombosis, in turn, leads to tissue necrosis and bone destruction.