Pulmonary mucormycosis masquerading as endobronchial tumour in an immunocompetent pregnant young lady

Abstract

Pulmonary mucormycosis is a rare but rapidly progressing and life‐threatening fungal infection, usually affecting immunocompromised patients. We report a case of a previously healthy young lady who presented with prolonged cough, weight loss, and haemoptysis. Imaging showed left hilar mass with infiltration into the left main bronchus and concurrent mediastinal lymphadenopathy. Flexible bronchoscopy revealed an endobronchial mass occluding the left main bronchus. Tumour debulking was performed using rigid bronchoscopy with cryoprobe and snares. Histopathological examination revealed inflamed tissue with fungal organism. Fungal polymerase chain reaction (PCR) confirmed Rhizopus microsporus . She was treated with two weeks of intravenous amphotericin‐B with complete clinical and radiological resolution.

Isolated tracheobronchial mucormycosis: Report of a case and systematic review of literature

“…Our search yielded 1540 citations, of which 157 were eligible for a detailed review (Figure 4). We identified 25 unique cases satisfying our inclusion criteria from 24 publications 16–39 . We summarise the 26 cases (including the index patient) of isolated tracheal or bronchial mucormycosis in Table 1.…”

“…In all the cases, histopathology suggested the diagnosis. The species was identified in only four cases ( Rhizomucor , n = 2; Rhizopus microsporus , n = 1; Rhizopus oryzae , n = 1) 24,29,34,39 …”

“…Amphotericin B deoxycholate was used for inhalation in 5/26 (19.2%) subjects and intrabronchially instilled during flexible bronchoscopy in one case 24,25,29,37 . Therapeutic bronchoscopy to relieve luminal obstruction or to establish a diagnosis was undertaken in 30.8% of the cases, including cryotherapy ( n = 3), mechanical debulking ( n = 2), ND‐YAG LASER ( n = 1), argon plasma coagulation ( n = 1), snaring ( n = 1) and mucus plug extraction ( n = 1) 21,24,25,27,33,34,37,39 . Tracheal resection and anastomosis ( n = 2), debridement ( n = 2), mediastinoscopy ( n = 1) and pneumonectomy ( n = 1) were the surgeries performed 18,19,23,28,30,35 …”

“…The species was identified in only four cases (Rhizomucor, n = 2; Rhizopus microsporus, n = 1; Rhizopus oryzae, n = 1). 24,29,34,39…”

“…24,25,29,37 Therapeutic bronchoscopy to relieve luminal obstruction or to establish a diagnosis was undertaken in 30.8% of the cases, including cryotherapy (n = 3), mechanical debulking (n = 2), ND-YAG LASER (n = 1), argon plasma coagulation (n = 1), snaring (n = 1) and mucus plug extraction (n = 1). 21,24,25,27,33,34,37,39 Note: The values are presented as the observed number/total number of patients for which the data is available (n/N; %), unless specified otherwise.…”