Chronic pulmonary mucormycosis caused by rhizopus microsporus mimics lung carcinoma in an immunocompetent adult:A case report

BACKGROUND Pulmonary mucormycosis is a rare but life-threatening invasive fungal infection that mostly affects immunocompromised patients.This disease usually develops acutely and progresses rapidly,often leading to a poor clinical prognosis.Chronic pulmonary mucormycosis is highly unusual in immunocompetent patients.CASE SUMMARY A 43-year-old man,who was a house improvement worker with a long history of occupational dust exposure,presented with an irritating cough that had lasted for two months.The patient was previously in good health,without dysglycemia or any known immunodeficiencies.Chest computed tomography revealed a mass in the left lower lobe,measuring approximately 6 cm in diameter,which was suspected to be primary lung carcinoma complicated with obstructive pneumonia.Thoracoscopic-assisted left lower lobectomy was performed,and metagenomic next-generation sequencing detection,along with special pathological staining of surgical specimens,suggested Rhizopus microsporus infection.Postoperatively,the patient’s respiratory symptoms were relieved,and no signs of recurrence were found during the six-month follow-up.CONCLUSION This article reports a rare case of chronic pulmonary mucormycosis caused by Rhizopus microsporus in a middle-aged male without dysglycemia or immunodeficiency.The patient’s surgical outcome was excellent,reaffirming that surgery remains the cornerstone of pulmonary mucormycosis treatment.

Use of bronchoscopy-guided treatment and oral posaconazole to treat pulmonary mucormycosis:a case report and literature review

Background:Pulmonary mucormycosis(PM)is rare condition,which is difficult to diagnose and has a high mortality rate.Currently,there is a lack of effective drugs,with few side effects,to treat PM.There have been a few reports on the use of bronchoscopy and posaconazole for the treatment of adult PM.Methods:A man with diabetes mellitus developed diabetic ketoacidosis and subsequently developed repeated cough,hemoptysis,and fever.He was diagnosed with pneumonia and was treated with antibiotics in a local hospital.However,his condition worsened.After admission to our hospital,chest computed tomography(CT)showed bilateral pneumonia and cavities in the left upper lobe that were significantly worse than those seen previously.Bronchoscopy revealed swelling of the left bronchial mucosa and yellow necrosis adhering to the wall.Histology of transbronchial lung biopsy specimens revealed PM pneumonia,characterized by numerous mucormycelia,spores,and neutrophils between necrotic debris.Results:Following diagnosis,liposomal amphotericin B was administered intravenously,and although the symptoms improved significantly,side effects caused the patient to discontinue taking the drug.An alternative regimen,including oral posaconazole and local injection of amphotericin B was administered via bronchoscopy.Finally,the patient did not experience any discomfort and chest CT showed complete resolution of the consolidation and the lung cavity.Conclusion:Bronchoscopy can play an important role in the diagnosis and treatment of PM.The combination of oral posaconazole and bronchoscopy-guided anti-infective therapy is a novel and effective way to treat PM for patient cannot tolerate liposomal amphotericin B.

A Rare Case of Pulmonary Mucormycosis Successfully Treated with Dual Antifungal Agents and Surgery in a Patient with Uncontrolled Diabetes

Pulmonary mucormycosis is an emergent and life-threatening invasive fungal infection underdiagnosed by clinicians due to unspecific clinical picture and lack of awareness. Although the acknowledgment of risk factors, clinical and radiological findings may increase early recognition, the definite diagnosis is challenging to establish and the ideal treatment has never been delineated. The authors describe a rare case of pulmonary mucormycosis that was successfully treated with dual antifungal treatment and surgery in a patient with uncontrolled diabetes. When last evaluated, he was asymptomatic with no evidence of relapse. To our knowledge this is a rare report of a successfully treated diabetic patient with pulmonary mucormycosis with L-AmB, triazole posaconazole and surgery with no evidence of recurrence. We highlight the importance of clinicians’ awareness to early diagnosis, combined antifungal treatment and adjuvant surgery as the greatest chance of cure of a rapidly progressive disease with high mortality and morbidity.

A diagnosis neglected for 6 years： report of a misdiagnosed case of pulmonary mucormycosis and review of the literature

Pulmonary mucormycosis is an uncommon and often fatal opportunistic fungal infection caused by fungi in the class zygomycetes of the order mucorales. As a rare clinical entity characterized by acute onset, rapid progression and high mortality rate, pulmonary mucormycosis often results in fatal consequences within two years after the onset, and can be easily misdiagnosed. Here we report a case of pulmonary mucormycosis for which a definite diagnosis had not been established until 6 years after the initial onset.

PULMONARY MUCORMYCOSIS: A CASE REPORT AND SYSTEMIC REVIEW OF LITERATURE

Pulmonary mucormycosis is an increasingly emerging life-threatening infection caused by the order Mucorales (class Zygomycetes). A high index of suspicion in the appropriate clinical setting with prompt diagnosis and optimal treatment is recommended. We made a systemic analysis of 82 reported cases in literature in order to improve clinical knowledge of pulmonary mucormycosis. We described a patient with localized pulmonary mucormycosis diagnosed by histological examination in our hospital. Optimal therapy consists of antifungal medication, surgical resection and control of the patient's underlying illness.

Rhizopus microsporus lung infection in an immunocompetent patient successfully treated with amphotericin B:A case report

BACKGROUND Rhizopus microsporus(R.microsporus)lung infection is an invasive fungal disease with high mortality that is increasingly common in immunocompromised patients.However,it is very rare in immunocompetent patients.Here,we present the case of a 19-year-old girl who developed R.microsporus lung infection without any known immunodeficiency.CASE SUMMARY The patient presented to our hospital because of hemoptysis and irritative cough without expectoration.She was first treated for community-acquired pneumonia until the detection of R.microsporus in bronchoalveolar lavage fluid by metagenomics next-generation sequencing(mNGS).After a combination therapy of intravenous inhalation and local airway perfusion of amphotericin B,she eventually recovered,with significant absorption of lung infections.CONCLUSION Early diagnosis and treatment are very important for pulmonary mucormycosis.Compared to fungal culture,mNGS is a relatively precise and convenient method to obtain pathogenic results.A combination therapy of intravenous inhalation and local airway perfusion of amphotericin B may be a promising strategy for the treatment of pulmonary mucormycosis in the future.