A rare case of pulmonary mucormycosis apparent as difficult to extract mucus-plug per bronchoscopy

ABSTRACT

Background: Pulmonary mucormycosis, a rare pulmonary fungal disease, is difficult to diagnose and lacks effective treatment. Diabetes mellitus, systemic corticosteroid therapy, neutropenia, hematologic malignancies, stem cell transplant, Covid-19 infection and immunocompromised state are the predisposing situations for mucormycosis. There are no reliable serological, PCR-based, or skin tests. Bronchoscopy guided biopsy proved to be effective for early diagnosis. Case Study A 47 years old female patient, known Diabetic, presented with complains of Dry Cough and fever. Patient had past history of COVID-19 pneumonia. HRCT showed mucus plugging with collapse of left lower lobe. During Bronchoscopy, mucus plug was difficult to extract despite using mucolytics;then biopsy was taken which turned out to be MUCORMYCOSIS. Patient was treated with injectable Amphotericin B for 4-weeks and then Tablet Posaconazole. Patient was improved on follow up. Discussion: Pulmonary Mucormycosis is a rapidly progressive infection that occurs after inhalation of spores. Most patients are presented with fever, cough and hemoptysis. After Covid-19 pandemic, cases of mucormycosis are on rise. Pulmonary Mucormycosis is rare entity than Rhino-orbito-cerebral mucormycosis. Biopsy remains mainstay for diagnosis. Conclusion: Pulmonary Mucormycosis being rare lifethreatening opportunistic infection;early diagnosis and treatment is necessary for better outcome and survival.