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A5416 - Pulmonary Mucormycosis Mimicking Pneumonia
Author Block: T. M. Arab1, T. Ullah2, M. Malekzadegan1, G. Martinez3, F. Bagheri4, S. Sarkar1, M. Mora5, N. Pathak3; 1Pulmonary Medicine, Jamaica Hospital Medical Center, Jamaica, NY, United States, 2Clinical Research, Jamaica Hospital Medical Center, Jamaica, NY, United States, 3Internal Medicine, Jamaica Hospital Medical Center, Jamaica, NY, United States, 4Infectious Disease, Jamaica Hospital Medical Center, Jamaica, NY, United States, 5Pathology, Jamaica Hospital Medical Center, Jamaica, NY, United States.
Pulmonary Mucormycosis Mimicking Pneumonia in a Diabetic Patient
Introduction
Pulmonary mucormycosis is a relatively rare, life-threatening, opportunistic infection that
typically affects immunocompromised patients. Approximately 32% of cases of mucormycosis have comorbid diabetes. Symptoms often mimic pneumonia. When left untreated this infection carries a high mortality rate (76%) due to its rapid progression.
Here we present a case of pulmonary mucormycosis in a diabetic patient who was misdiagnosed with pneumonia. Management is discussed.
Case:
A 53-year-old female patient presented with progressive dyspnea, hemoptysis, weight loss, and fever for about a month. Her symptoms began while on vacation to Guyana where she was prescribed antibiotics for pneumonia. She was a non-smoker and had a past medical history of diabetes.
On current admission, patient complained of chills. She had rales on chest auscultation.
Laboratory investigations was significant for mild leukocytosis (12.8 K/uL) and hyperglycemia (374 mg/dL). Chest X-ray revealed right perihilar masslike lesions. CT of the chest showed a peculiar pattern of diffuse peribronchovascular lesions of varying sizes and a solid ring with central ground glass opacities (reversed halo sign) and cavitation. The patient was started on a broad spectrum antifungal agent for fungal pneumonia. Sputum examination did not reveal acid fast bacilli. Bronchoscopy with transbronchial biopsy was performed, which confirmed the presence of mucormycosis. The patients’ treatment was adjusted with posaconazole and she tolerated the treatment with gradual improvement.
Discussion:
Mucormycosis is caused by infectious fungi of the order Mucorales, most commonly the Mucor, Rhizopus, and Litchthemia species.
The diagnosis of pulmonary mucormycosis is difficult since the presentation is similar to
pneumonia. Radiographic findings may demonstrate focal consolidation, masses, pleural
effusions, or multiple nodules. A reversed halo sign ̶ ground glass attenuation surrounded by dense, concentric ring ̶ seen on high resolution CT, is characteristic of angio-invasive fungi. Amphotericin B and a few azole agents were the mainstay anti-fungal therapy, but newer potent triazoles, like posaconazole, are now recommended.
The duration of therapy is determined by clinical response, normalization of radiological
findings, and negativity of cultures.3 Early diagnosis is the key to improving the likelihood of
survival. This case highlights the importance of distinguishing pulmonary mucormycosis from pneumonia.
A cut of chest CT showing cavitary lesions