Bronchoscopic management of tracheobronchial mucormycosis

ABSTRACT

Introduction: Mucormycosis is a catastrophic, opportunistic infection with a high mortality rate. Incidence of Pulmonary mucormycosis has gone up in the post covid-19 era. Treatment includes combined surgical and medical therapy. Mucormycosis involving major airway is difficult to treat because, the surgical options are limited. We present a case series of tracheobronchial mucormycosis, managed by combined bronchoscopic interventions and medical therapy. Case Series Case 1 30 years old diabetic female presented with stridor. Bronchoscopy showed mass lesion arising from carina extending to lower trachea causing obstruction. Biopsy revealed Mucormycosis. The lesion was completely debulked by using rigid bronchoscopy, cryoprobe, electrosurgical knife. Intravenous amphotericin was for 6 weeks. Follow-up bronchoscopy showed no recurrence. Case 2 45 years old diabetic male who had Covid-19 recently, presented with cough. Bronchoscopy revealed near-total occlusion left main bronchus by fleshy lesion destroying medial wall and communicating with the mediastinum. Lesion was removed by bronchoscopic methods and intra-lesional amphotericin was injected in multiple sittings along with intravenous amphotericin therapy followed by oral posaconazole. Follow-up bronchoscopy showed complete healing of left main bronchus. Case 3 25-year-old diabetic male, presented with stridor. Bronchoscopy revealed complete destruction of the upper trachea by necrotic infection extending to paratracheal tissue on right side. Silicon tracheal stent was placed to stabilize trachea and patient was continued on intra-lesional and intravenous amphotericin therapy. Interim bronchoscopy in after 2 weeks showed partial healing of the lesion however patient missed for follow up after 3 weeks of amphotericin therapy. Conclusion: Surgical options for tracheobronchial mucormycosis are limited. Bronchoscopic methods may be tried to treat the disease locally along with intravenous amphotericin therapy when Surgical options are exhausted.