Pulmonary Mucormycosis: A Case Report and Systematic Review of the Literature

Abstract

The pulmonary mucormycosis (PMM) caused by Mucorales is a highly lethal invasive fungal infection in which early diagnosis and management is imperative. Otherwise, the mortality may exceed 80%. PMM does not have specific symptoms; hence, awareness of the disease and the treating physician’s suspicion can detect or diagnose it earlier. The fungal infection also needs to be differentiated from aspergillosis and other common fungal infections so an appropriate treatment is instituted.Case Report: A 62-year-old male was admitted with a six-month cough with scanty expectoration and a short history of progressive breathlessness for the last five days. He had a known case of diabetes and also an old-treated case of tuberculosis. He had a history of COVID-19 pneumonia (without a positive report). No history of fever, chest pain and hemoptysis. However, chest X-ray and HRCT thorax revealed a fibro-cavitary lesion in the right upper lobe with sputum and CBNAAT negative for AFB. The FOB examination detected complete occlusion with protruded soft yellowish and black material in the right main upper lobe bronchus, which was reported as mucormycosis. The patient was treated with amphotericin and then with oral antifungal.Discussion: An upsurge of mucormycosis was reported in our country during the COVID-19 era, leaving behind aspergillosis and another fungus. The rhino-orbit-cerebral is the most common site for this fungal infection and is essentially reported in an immune-compromised host as happened in our diabetic patient but as PMM. The Post TB sequelae with residual fibro-cavitary lesions, COPD and solid organ transplantation cases are the other risk factors and our country has enough of a vulnerable population. Our case was detected in the post-Covid period and required attention to epidemiological change or something else?Conclusion: An early rapid diagnosis and management of mucormycosis is crucial to minimizing mortality. The treatment by amphotericin is the best choice followed by Posaconazole or Isavuconazole as step-down oral medication. The increasing incidence of this infection in our country is challenging,