A rare case of pulmonary mucormycosis in a diabetic patients

ABSTRACT

Introduction: Mucormycosis is an emerging angioinvasive infection caused by the ubiquitous filamentous fungi of the mucorales order of the class of zygomycetes. It has emerged as one of the most common invasive mycosis in patient with hematological and allogeneic stem cell transplantation. It also remains threat in diabetic and also recently in post covid patients. Case Report A 62 year old male farmer patient came with complaints of cough with expectoration, fever, moderate hemoptysis and headache. Patient is having uncontrolled diabetes mellitus. All routine blood investigations and coagulation profile was normal. CECT Thorax suggestive of ring like opacities with areas of ground glass opacities surrounded by ring of consolidation suggestive of fungal pneumonia. Simultaneously patient is having severe throbbing headache. So MRI brain with orbit and paranasal sinus done, which suggestive of ethamoidal sinusitis ,osteomyelitis of clivus. Hence IV antifungal amphotericin b started as immediate measure in a view of disseminated fungal infection with strict glycemic control. Sputum smear, microscopy, bacterial culture, gene xpert are negative. Lung biopsy done which suggestive of branching ribbon like hyphae. Hence patient posted for right upper lobectomy. Patient discharged on Tab. Posaconazole. Patient came follow up after 3 months , symptomatically improved and radiological resolution of lesions of chest xray. Conclusion: Mucormycosis is a life threatening infection, and usually the diagnosis late because of nonspecific clinical ,radiological features and need biopsy for confirmation of the organism. The cornerstone for the management and increase the survival rate remain on rapid diagnosis ,treatment of the underlying predisposing condition and urgent surgical debridement.