Mucormycosis is an opportunistic pathogen in the zygomycetes class. Pulmonary mucormycosis results by inhalation of sporangiospores into the bronchioles and alveoli. Clinical and radiological findings of the disease are nonspecific. Infarction or necrosis can lead to pneumonia and the infection can spread to neighbouring structures such as the mediastinum and heart, or hematogenously spread to other organs. The radiological manifestations of pulmonary mucormycosis are mostly non-specific. Patch-like consolidations and cavitary lesions can be seen on chest graphy. Hemoptysis is a fatal complication. We report a case of pulmonary mucormycosis in an adolescent diabetic patient as such cases have been rarely reported in literature.
A 16-year-old girl presented with complaints of fever, chills, fatigue, cough, and shortness of breath. Patient was admitted to the hospital with the diagnosis of diabetic ketoacidosis and pneumonia. The patient was diagnosed with Type 1 DM for 5 years. There was a history of exposure to mould when cotton was collected for a long period of 1 month in cotton field about 1 month ago. There was no tuberculosis contact history. The patient had a temperature of 38.7°, a pulse rate of 110 beats/min, a respiratory rate of 34 breaths/min. Bilateral common crepitation ral and ronkus were present in the osculation. Thorax computed tomography (CT) scans showed bilateral infiltrative areas and and cavitary lesions in the left lung.
Throat swab and blood cultures for bacteria and fungus were obtained, but did not reveal any pathogens. Sputum smears for acid-fast bacilli were negative, and galactomannan testing (GM) for diagnosing invasive aspergillosis was negative. The patient clinically improved following intravenous meropenem, vancomisin, amphotericin B and caspofungin empirically for one week, however, radiography showed progression. Therefore we performed flexible bronchoscopy.
Sputum samples were found to be positive for fungal elements by microscopy and culture of sputum samples as well as the bronchial wash showed growth of Rhizopus species.
On the sixteen day of antifungal therapy, patient had a massive bout of haemoptysis and died from the disease. Pulmonary mucormycosis should be considered in cavitary lung infections, especially when accompanied by diabetes.