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Difficulty in diagnosing pulmonary mucormycosis

Michael P. Lawler, Mary Pat Hendy

Am J Case Rep 2009; 10:75-77

ID: 869657


Background: Pulmonary mucormycosis is a rare fungal infection that primarily affects immunocompromised patients. It’s an opportunistic disease that can cause a variety of severe infections and frequently death. Making the diagnosis can be quite challenging.
Case Report: A 59-year-old man consulted his physician regarding coughing and dyspnea and was given antibiotics for presumed acute bronchitis. One week later a chest x-ray showed pulmonary infiltrate and the patient was found to be pancytopenic. A bone marrow biopsy revealed hairy cell leukemia and chemotherapy was started. The physical examination revealed decreased breath sounds at the lung bases. The patient was pan-cultured and started on Vancomycin and Piperacillin for broad antibiotic coverage. He continued to have spiking fevers and cough, so Fluconazole was added for antifungal coverage. He was pan-cultured again: sputum cultures grew mucormycosis. He was started on amphotericin B, but his condition continued to worsen and he expired three days later.
Conclusions: This case demonstrates how clinical diagnosis is often difficult and delayed. There are many different infections that can cause pulmonary diseases in immunocompromised patients. Therefore, the clinician must consider mucormycosis in the differential diagnosis of pulmonary infection in immunocompromised hosts. Early medical and surgical treatment must be initiated if there is a high clinical suspicion.

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