Pulmonary Mucormycosis With Endobronchial Lesion Presented as Recurrent Hemoptysis for Five Years

Abstract

INTRODUCTION: Mucormycosis is a rare, opportunistic infection caused by fungi belonging to the class Zygometes, genus Mucor. Pulmonary mucormycosis is an uncommon infection that occurs mostly in immunocompromised persons. We reporting a rare case of pulmonary mucormycosis with endobronchial lesion presented as recurrent hemoptysis CASE PRESENTATION: 37- year- old male with history of end stage renal disease, type II diabetes, hepatitis C presented with mild intermittent hemoptysis for 5 years, getting worse over the last 2 months. Examination revealed decrease breath sound on the right side and laboratory tests were significant for Creatinine 5.6 mg/dl and blood glucose level 303 mg/dl. A chest radiograph and computed tomography of chest revealed large right effusion .Mycobacterium tuberculosis was ruled out also sputum culture and vasculitis works up were negative. Underwent thoracentesis with removal of two liters of monocyte predominant exudate, culture and cytology of the fluid were negative and repeated computed tomography of chest after showed 4 cm mass in the right lower lobe. Bronchoscopy demonstrated bleeding circumferential mass in the superior segment of right lower lobe and cytology of bronchial wash was negative. CT quided biopsy of the lesion showed a ball of non septate, broad hyphae suggestive of zygomycetes likely mucormycosis. The patient was started on Lipososmal Amphotericin B and continued to have hemoptysis. Underwent right lower lobectomy and pathology showed fungus ball in the lumen of the bronchus composed of non-septate broad hyphae similar to the parenchymal lesion. The patient improved and was discharged on oral Posaconazole DISCUSSION: Pulmonary mucormycosis is a rare opportunistic fungal infection typically develops in immunocompromised patients. Diabetes is the most common risk factor followed by hematologic malignancies and solid organ transplantation (1).Endobronchial mucormycosis is a rare presentation of pulmonary mucormycosis that often associated with high mortality due to massive hemoptysis. Diagnosis mainly by identification of organisms in tissue by histopathology and rarely obtained by cultures (2) .Management should combined surgical debridement and antifungal therapy with controlling the underlying conditions (2). Amphotericin B remains the main agent in mucormycosis and Posaconazole is also an option for oral therapy. Despite early diagnosis and aggressive combined surgical and medical therapy, the prognosis remains poor and mortality is high CONCLUSIONS: Our patient is a rare case of pulmonary mucormycosis with endobronchial lesion causing recurrent hemoptysis. In the right clinical setting, mucor should be considered in the differential diagnosis of airway lesions and hemoptysis with uncontrolled diabetes.