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Chronic pulmonary mucormycosis: an emerging fungal infection in diabetes mellitus

May 10 2017

Three cases of chronic pulmonary mucormycosis have been reported from Pakistan in patients (all females in their 60s) with poorly controlled diabetes mellitus and with no other underlying conditions. 

In this report by Igbal et al 2017, productive cough, fever, haemoptysis and shortness of breath were the main clinical presentations of pulmonary mucormycosis; all the patients had poorly controlled diabetes with HbA1c ranging from 9.4 to 13.1%. Diagnostic bronchoscopy was performed on all the patients with subsequent histopathology demonstrating numerous aseptate hyphae. Fungal culture of bronchoalveolar lavage sample yielded Rhizopus species in one of the patients. Two patients with unilateral disease improved on intravenous amphotericin B deoxycholate and surgery (lobectomy/pneumonectomy). A patient with bilateral disease in whom surgery was not advisable responded on amphotericin B deoxycholate treatment only.

CT chest showing fibrocavitary changes on right side of lung. CT, computed tomographic. (Figure 4. Igbal et al.)

Mucormycosis occurs in patients with poorly controlled diabetes, leukemic disorders, and patients undergoing solid organ or hematopoietic stem cell transplantation or neutropenia. The most common presentation being gastrointestinal tract, skin, lungs, central nervous system, eye orbit and the paranasal sinuses disease.  Pulmonary mucormycosis is very rare, often acute, and is associated with very high morbidity and mortality. Chronic pulmonary mucormycorsis has been reported in patients with chronic obstructive pulmonary disease (Benekli, 2004) and chronic rejection of kidney transplant (Talebi-Taher et al, 2015).

Histopathology showing large collections of non-septate branching hyphae on Haematoxylin & Eosin stain. (Figure 2.Igbal et al . )

The clinical and radiological manifestations of pulmonary mucormycosis mimics pulmonary tuberculosis imposing diagnostic challenge especially in areas were TB is endemic.

Article: J Thorac Dis 2017;9(2):E121-E125