Abstract
Primary mucormycosis is a rare and serious fungal disease with high morbidity and mortality mostly seen in immunocompromised patients. Treatment includes antifungal therapy as well as surgical resection because antifungals alone are insufficient. We describe a case of a lung transplant (LT) patient with endobronchial mucor cured with bronchoscopic resection and systemic antifungal therapy.
A 27-year-old woman with cystic fibrosis underwent bilateral LT in December 2019. Two years after transplant, she presented to clinic with declining pulmonary function tests and dyspnea. Chest imaging showed bilateral lower lobe consolidations. Bronchoscopy showed mucoid yellow secretions mainly in the left upper lung but scattered in both sides (Figure 1A, B). The lingula was densely filled with completely snared white material, which was biopsied and cultured. Bronchoalveolar lavage fluid obtained from the right middle lobe grew pseudomonas aeruginosa immediately, while lavage fluid from the lingula and biopsied material grew rhizopus a few days later. The patient first began antipseudomonal therapy, and systemic antifungal therapy was added later. Given the imaging changes and culture results, surgical resection of the left upper lobe was considered. However, as repeat inspection bronchoscopy one month after therapy initiation showed healthy-looking airways with no secretions (Figure 1C, D) and CT images improved, the multi-disciplinary team decided to continue medical therapy alone. All follow-up bronchoscopies were negative for rhizopus with complete resolution of the disease process.
In solid organ transplant recipients with primary mucormycosis, surgical intervention with resection of the involved area may increase the chance of survival. However, when the disease is limited without deep invasion into the lung parenchyma, disease control and resolution without surgical intervention can be considered, particularly in patients who are not good surgical candidates.