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A5415 - Pulmonary Mucormycosis a Successful Dual Treatment Case Report
Author Block: K. Jassen Avellaneda1, E. Becerril Vargas2, M. Ramirez Candelas1, R. Robles Hernandez1; 1Enseñanza, Instituto Nacional de Enfermedades Respiratorias, Tlalpan, Mexico, 2microbiology, Instituto Nacional de Enfermedades Respiratorias, Tlalpan, Mexico.
Introduction: Mucormycosis is an aggressive fungal infection; considered to be rare in the worldwide population. Thus, pulmonary Mucormycosis is unusual an opportunistic angioinvasive fungal infection, it is pondered as the second presentation more common after rhinocerebral Mucormycosis cases. This entity is related to immunocompromised patients (neoplastic and hematologic malignancies or diabetic status). The prompt and targeted usage of antifungal treatment improves the outcomes for patients. First line treatment is based on amphotericin B, continued by posaconazole and isavuconazole. Clinic Case: we report the study of a 36-year-old Mexican masculine patient with Diabetes Mellitus type 2 since 2016 in treatment with glargine and metformin without control, who was hospitalized for one month on a private hospital for diverticular disease, requiring 15 days in critical care unity without mechanical ventilation. He arrived to our institution with pulmonary symptoms (productive cough, exertional dyspnea and 38 grades fever) of 10 days of evolution. The patient was hospitalized with systemic response syndrome, microcytic hypochromic anemia and hypomagnesemia. In the chest x-ray we observed a disseminated micronodular pattern. In the high-resolution lung computed tomography, we spotted a diffuse tree in bud pattern. A bronchoscopy was realized for taking biopsies. The lung biopsy demonstrated Mucormycosis active infection, even though bronchoscopy cultures were negative. He received a cumulative dose of 4,900 milligrams Amphotericin B in 14 days. The patient was dispatched home with a cumulative dose of 22.4 grams Posaconazole in 4 weeks, with symptomatology recovered at 100%. 6 months after diagnosed, he required an upper right lobectomy, without complications. Discussion: The usage of new triazoles for Mucormycosis infections has been controversial because of the poor number effective case reports responding to this treatment. Liposomal amphotericin B it is the first line treatment, but in Mexican Health institutions has been unaffordable this treatment. The treatment used in this case was 100% successful, the upper right lobule had extended secondary affections, requiring surgery. In patients with immunocompromised disorders that don’t respond to antibiotics we should considered this type of infections, and trying new treatment alternatives. We must remember that pulmonary Mucormycosis infections has up to 76% mortality and 28% mortality in the first 28 days.