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A5423 - A Case of Disseminated Pulmonary Mucormycosis Mimicking Malignancy Treated with Intrabronchial Antifungal
Author Block: V. Sundarasamy1, M. Rafiq2; 1Chest and Tuberculosis, Vinayaka missions medical college, Karaikal, India, 2Radiology, Vinayaka missions medical college, udumalpet, India.
Introduction: Mucormycosis ,a life threatening angioinvasive fungal infection ,a great mimicker of other lung infections is more common in immunocompromised patients.We report a case of Disseminated Pulmonary Mucormycosis in a diabetic patient which mimicked like malignancy , diagnosed with tissue biopsy, treated with antifungal drug both intravenously and intrabronchially which led to the cure of the patient. Case report: 50 years old male a known diabetic was admitted with chief complaints of cough with expectoration for 2 months.Expectoration was copious ,mucoid and foul smelling . History of loss of appetite and weight with fever were also present.Patient has got admitted twice during the past 8 months for similar complaints. Initially a diagnosis of necrotising pneumonia was made and started on sensitive intravenous antibiotic for Klebsiella pneumonia according to bronchial wash culture and sensitivity. After 4 months of discharge patient came back with the similar complaints .With previous history and workup ,chest x-ray and CT Chest taken now showed a large cavity with airfluid level in the left upper zone . Klebsiella pneumonia was isolated again with similar sensitivity from bronchial wash.After a duration of 2 weeks with intravenous antibiotic patient was discharged .Again after 3 months now in this present admission for similar complaints,CT scan Chest done showed a peripherally enhancing mass lesion with central necrotising area in left upper lobe with erosion of second rib and extra-pleural extension suggestive of neoplasm .Finally to rule out the ambiguity ultrasound guided biopsy done showed mucormycosis growth with no malignant cells . Patient was started on intravenous amphotericin B .Since patient was not willing for intravenous injections of antifungal for weeks to months as it was supposed to be given until resolution , intrabronchial Amphotericin at a weekly interval was given. Patient got discharged at request and when he came back after 2 months there was complete radiological resolution and patient asymptamatic. Discussion Diagnosing pulmonary mucormycosis is challenging because of its varied presentations.Histopathological examination remains the propable gold standard for diagnosis.Adding to the difficulty of diagnosing the disease is the treatment part because of its long duration as well as the adverse effects of the antifungals.Hence multimodalities of treatment ,locally in the form of intrabronchial injections and systemic formulations should be used to reduce the mortality of the disease.