Challenges in the diagnosis of pulmonary mucormycosis in a diabetic with a review of literature

Muhammad Yousaf; Sarah Salameh; Irfan Ul Haq; Samir Alhyassat; Merlin Thomas; Aisha Hussain; Mohd Wani; Ehab Massad; Hamad Abdel Hadi; Hisham Abdul Sattar; Mansoor Hameed

doi:10.1016/j.rmcr.2021.101474

Challenges in the diagnosis of pulmonary mucormycosis in a diabetic with a review of literature

Respir Med Case Rep. 2021 Jul 8:33:101474. doi: 10.1016/j.rmcr.2021.101474. eCollection 2021.

Authors

Muhammad Yousaf^{1

2}, Sarah Salameh^{2

3}, Irfan Ul Haq^{4

2}, Samir Alhyassat⁵, Merlin Thomas^{4

2}, Aisha Hussain⁴, Mohd Wani⁶, Ehab Massad⁶, Hamad Abdel Hadi³, Hisham Abdul Sattar⁴, Mansoor Hameed^{4

2}

Affiliations

¹ Hazm Mebaireek Hospital, Hamad Medical Corporation, Doha, Qatar.
² Weill Cornell Medicine-Qatar, Cornell University, Doha, Qatar.
³ Communicable Diseases Centre, Hamad Medical Corporation, Qatar.
⁴ Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.
⁵ Department of Laboratory Medicine and Pathology, Hamad Medical Corporation, Qatar.
⁶ Department of Cardiothoracic Surgery, Hamad Medical Corporation, Qatar.

Abstract

Diabetes Mellitus appears to be the most common underlying condition associated with mucormycosis; a rare opportunistic fungal infection associated with high morbidity and mortality. Pulmonary mucormycosis may mimic pneumonia and thus pose challenges in achieving a timely diagnosis critical to successful outcomes. We present a case of a 65-year-old diabetic who presented with fever and haemoptysis that was managed as pneumonia. A bronchial alveolar lavage grew Rhizopus mould that was thought to be a contaminant as he responded well to antibiotics. He required another admission in 4 weeks due to worsening symptoms. Failure to respond to antibiotics and ongoing clinical and radiological deterioration led to a lobectomy that confirmed a diagnosis of pulmonary mucormycosis. He responded well to surgical resection and antifungal therapy with a complete recovery. Elusive clinical presentation and insensitive conventional diagnostic techniques may make the diagnosis of mucormycosis challenging. Our case reports highlight the issues involved in the diagnosis and management of pulmonary Mucormycosis mimicking as pneumonia.

Keywords: Antifungal; Diabetes; Hemoptysis; Invasive fungal infections; Mucormycosis; Pneumonia; Zygomycosis.

Publication types

Case Reports