Pulmonary Mucormycosis Presenting as an Endobronchial Lesion

doi:10.1378/chest.106.6.1889

Chest

Volume 106, Issue 6, December 1994, Pages 1889-1891

https://doi.org/10.1378/chest.106.6.1889 Get rights and content

A 56-year-old diabetic man presented with left upper lobe collapse and postobstructive pneumonitis. Fiberoptic bronchoscopy revealed an endobronchial mass obstructing the left mainstem bronchus. The lesion resembled a bronchial adenoma; however, cytologic and histologic examination revealed invasive mucormycosis. The patient was treated with intravenous amphotericin B followed by endoscopic laser surgery that relieved the obstruction.

Section snippets

CASE REPORT

A 56-year-old Hispanic man was admitted to the hospital for evaluation of cough, fever, chills and left-sided pleuritic chest pain of 2 weeks' duration. He was a type II diabetic and his diabetes had been poorly controlled by diet alone. Physical examination showed a normal head, ears, eyes, nose, and throat. Chest auscultation revealed decreased breath sounds over the entire left hemithorax. Results of the remainder of the examination were unremarkable. A complete blood cell count showed a

DISCUSSION

Our patient illustrates an unusual presentation of pulmonary mucormycosis presenting as an endobronchial mass. Given the patient's presentation, the diagnosis of malignancy with postobstructive pneumonia was considered most likely.

Endobronchial mucormycosis has been described in the literature and the lesions have been identified as gray-white mucoid material that frequently block a major airway.5, 6, 7, 8 The involved airways are typically edematous and necrotic.³^,⁵ In our patient, no necrosis

REFERENCES (10)

BigbyTD et al.
Clinical spectrum of pulmonary mucormycosis.
Chest
(1986)
DonohueJF
Endobronchial mucormycosis.
Chest
(1983)
PaltaufA
Mycosis mucorina: Ein beitrag zur kenntniss der menschlichem fadenpilzee krankunger.
Virchows Arch Pathol Anat
(1885)
Glazer G, Webb WR. Laryngeal papillomatosis with pulmonary spread in a 69-year-old man. AJR 1979;...
TysonJC et al.
Recurrent mucormycosis of the paranasal sinuses in an immunologically competent host.
Otolaryngol Head Neck Surg
(1992)

There are more references available in the full text version of this article.

Cited by (36)

Endobronchial mucormycosis diagnosed by fiberoptic bronchoscopy
2023, IDCases
Endobronchial mucormycosis is very rare with only few cases reported in the literature. Here, we report a rare presentation of pulmonary mucormycosis in a diabetic patient who presented with left lung collapse. Bronchoscopy revealed an endobronchial growth, mimicking a tumor, causing complete occlusion of the left main bronchus. Histopathology confirmed the diagnosis of invasive mucormycosis.
Male patient 35 years old with accidental discovered Diabetes Mellitus, complained of hoarseness of voice and dry irritating cough that didn’t respond to antitussives and nonspecific treatment. CT chest was done and revealed left total lung collapse. Fiberoptic bronchoscopy was done and revealed total occlusion of the left main bronchus with whitish fungating glistening tissue from which biopsies were obtained. Histopathological examination was consistent with mucormycosis. A trial of medical treatment failed after which the patient was referred for surgical resection.
Successful treatment of mucormycosis requires early diagnosis; prompt administration of antifungal therapy, and surgical intervention when applicable. Aggressive surgical intervention to remove necrotic tissue is generally accepted as the therapeutic mainstay for endobronchial obstructing mucormycosis
Endobronchial mucormycosis: A rare clinical entity diagnosed by endobronchial cryobiopsy
2022, Respiratory Medicine Case Reports
Citation Excerpt :
Bronchoscopy usually reveals granulation tissue and grey-white mucoid material that frequently blocks the airway. The airways involved are typically edematous and necrotic, or lesions with an appearance suggestive of a bronchial adenoma [8]. In many cases, it is postulated that a submucosal, invasive fungal infection causes a submucosal abscess, which presents as an endobronchial mass [9].
Mucormycosis is a rare fungal infection caused by fungi of the order Mucorales. The rhino-cerebral form of mucormycosis is most commonly seen in patients with diabetes mellitus, whereas pulmonary mucormycosis is a rare manifestation in patients with hematological malignancy and transplant recipients. We report a case of a 40-year-old male, with history of poorly controlled diabetes, who presented to the emergency room with a one-week history of hemoptysis. Computed Tomography (CT) of the chest was concerning for a lung mass or abscess. Flexible bronchoscopy revealed an endobronchial lesion that was biopsied with a cryoprobe. Histopathologic examination showed non-septate right-angle branching hyphae, typical of mucormycosis. He underwent surgical resection of the right middle and lower lobes and treatment with antimycotic agents with a complete recovery. This case highlights the importance of early histopathological diagnosis of pulmonary mucormycosis in preventing a fatal outcome.
Mucormycosis: An emerging disease?
2006, Clinical Microbiology and Infection
Citation Excerpt :
Mucormycosis usually occurs in the at-risk population alongside other common diseases, e.g., cytomegalovirus infection, bacterial infection or even other fungal diseases [202,203,205–207]. Endobronchial or tracheal lesions are common [197,208–215], and vascular involvement of great vessels may be a cause of fatal haemoptysis [216–224]. Symptoms may appear after near-drowning episodes [225], and the differential diagnosis of necrotising pneumonia or lung abscesses should be considered [204].
Mucormycosis is the third invasive mycosis in order of importance after candidiasis and aspergillosis and is caused by fungi of the class Zygomycetes. The most important species in order of frequency is Rhizopus arrhizus (oryzae). Identification of the agents responsible for mucormycosis is based on macroscopic and microscopic morphological criteria, carbohydrate assimilation and the maximum temperature compatible with its growth. The incidence of mucormycosis is approximately 1.7 cases per 1000 000 inhabitants per year, and the main risk-factors for the development of mucormycosis are ketoacidosis (diabetic or other), iatrogenic immunosuppression, use of corticosteroids or deferoxamine, disruption of mucocutaneous barriers by catheters and other devices, and exposure to bandages contaminated by these fungi. Mucorales invade deep tissues via inhalation of airborne spores, percutaneous inoculation or ingestion. They colonise a high number of patients but do not cause invasion. Mucormycosis most commonly manifests in the sinuses (39%), lungs (24%), skin (19%), brain (9%), and gastrointestinal tract (7%), in the form of disseminated disease (6%), and in other sites (6%). Clinical diagnosis of mucormycosis is difficult, and is often made at a late stage of the disease or post-mortem. Confirmation of the clinical form requires the combination of symptoms compatible with histological invasion of tissues. The probable diagnosis of mucormycosis requires the combination of various clinical data and the isolation in culture of the fungus from clinical samples. Treatment of mucormycosis requires a rapid diagnosis, correction of predisposing factors, surgical resection, debridement and appropriate antifungal therapy. Liposomal amphotericin B is the therapy of choice for this condition. Itraconazole is considered to be inappropriate and there is evidence of its failure in patients suffering from mucormycosis. Voriconazole is not active in vitro against Mucorales, and failed when used in vivo. Posaconazole and ravuconazole have good activity in vitro. The overall rate of mortality of mucormycosis is approximately 40%.
Pulmonary mucormycosis presenting as endobronchial tumours-case reports
2005, Respiratory Medicine Extra
Pulmonary mucormycosis commonly presents as an invasive parenchymal consolidation with a rapidly progressive clinical course, and invasion of the airways and major vessels. Less commonly, it can present as endobronchial disease with involvement confined to a well localized area. We report two cases of endobronchial mucormycosis, who had endobronchial tumours and were diagnosed by bronchoscopic biopsy. They were managed medically and resolved following treatment with amphotercin. There are only four other cases of endobronchial mucormycosis presenting as tumour-like masses reported previously in the literature.
Mucormycosis in Systemic Lupus Erythematosus
2003, Seminars in Arthritis and Rheumatism
Objective: To describe a case of mucormycosis in systemic lupus erythematosus (SLE) and to review other patients reported in the English literature.
Method: A Medline search for articles about mucormycosis in SLE published between 1970 and 2002 was performed by using the key words “lupus,“ “mucormycosis,” “zygomycosis,“ “Mucorales,” “Rhizopus,” and “Mucor.” Cases were pooled for analysis, and the mycology, diagnosis, treatment, and outcome of mucormycosis in SLE was reviewed.
Results: Eight cases of mucormycosis in SLE were identified (female:male = 7:1). The mean age at the time of infection was 31.8 ± 7.6 years and the mean duration of SLE was 6.3 ± 3.9 years. All except 1 patient had active lupus and all were receiving high-dose corticosteroids. Concomitant cytotoxic agents were used in 4 patients. Additional predisposing factors for opportunistic infection included hypocomplementemia, nephrotic syndrome, uremia, leukopenia, and diabetes mellitus. The disseminated form of mucormycosis was the most common presentation and the diagnosis often was made only at autopsy (63%). For cases with positive culture results, Rhizopus was the causative species. In 4 patients, manifestations of the fungal infection mimicked those of active SLE. The overall mortality of mucormycosis was very high (88%) and, in most cases, was probably a function of delayed diagnosis and treatment. The cutaneous form appeared to have the best prognosis with combined medical and surgical treatment.
Conclusions: Mucormycosis is a rare but usually fatal fungal infection in SLE. Judicious use of immunosuppressive agents, a high index of suspicion, early diagnosis, and combination treatment with amphotericin B and surgical debridement may improve the prognosis of this serious infection.
Emerging Mucormycosis: Problems and Treatments
2023, Fungi and Fungal Products in Human Welfare and Biotechnology

View all citing articles on Scopus

View full text

Chest

Selected Reports: ArticlesPulmonary Mucormycosis Presenting as an Endobronchial Lesion

Section snippets

CASE REPORT

DISCUSSION

Chest

Chest

Mycosis mucorina: Ein beitrag zur kenntniss der menschlichem fadenpilzee krankunger.

Virchows Arch Pathol Anat

Recurrent mucormycosis of the paranasal sinuses in an immunologically competent host.

Otolaryngol Head Neck Surg

Selected Reports: Articles
Pulmonary Mucormycosis Presenting as an Endobronchial Lesion