A silent spore: when fungi take over the lung
DOI:
https://doi.org/10.18203/2349-3933.ijam20253355Keywords:
Diabetes, Fungal infection, Haemoptysis, Silent spore, Pulmonary mucormycosisAbstract
Pulmonary mucormycosis is a rare but aggressive opportunistic fungal infection, predominantly affecting immunocompromised individuals such as those with poorly controlled diabetes mellitus. This case report describes a 65-year-old diabetic woman who presented with fever, cough, haemoptysis, and rapidly progressing dyspnoea. Initial misdiagnosis as bacterial pneumonia delayed appropriate treatment. High-resolution computed tomography (CT) revealed the reverse halo sign and cavitary lesions, raising suspicion for an invasive fungal infection. Microbiological testing showed broad, aseptate hyphae with right-angle branching on potassium hydroxide (KOH) mount, consistent with mucormycosis, despite negative fungal cultures. She was treated with liposomal amphotericin B and later switched to oral posaconazole due to financial limitations. This case underscores the importance of early imaging and microbiological assessment in high-risk patients, especially those with uncontrolled diabetes. It also highlights diagnostic limitations in resource-constrained settings and the critical need for timely antifungal therapy to improve outcomes in pulmonary mucormycosis. Multimodal diagnosis and clinical vigilance remain essential for survival.
Metrics
References
Spellberg B, Edwards J, Ibrahim A. Novel perspectives on mucormycosis: pathophysiology, presentation, and management. Clin Microbiol Rev. 2005;18(3):556-69. DOI: https://doi.org/10.1128/CMR.18.3.556-569.2005
Georgiadou SP, Sipsas NV, Marom EM, Kontoyiannis DP. The diagnostic value of halo and reversed halo signs for invasive mold infections in compromised hosts. Clin Infect Dis. 2011;52(9):1144-55. DOI: https://doi.org/10.1093/cid/cir122
Lionakis MS, Kontoyiannis DP. Glucocorticoids and invasive fungal infections. Lancet. 2003;362(9398):1828-38. DOI: https://doi.org/10.1016/S0140-6736(03)14904-5
Ibrahim AS, Spellberg B, Walsh TJ, Kontoyiannis DP. Pathogenesis of mucormycosis. Clin Infect Dis. 2012;54:S16-22. DOI: https://doi.org/10.1093/cid/cir865
Chamilos G, Marom EM, Lewis RE, Lionakis MS, Kontoyiannis DP. Predictors of pulmonary zygomycosis versus invasive pulmonary aspergillosis in patients with cancer. Clin Infect Dis. 2005;41(1):60-6. DOI: https://doi.org/10.1086/430710
Roden MM, Zaoutis TE, Buchanan WL, Knudsen TA, Sarkisova TA, Schaufele RL, et al. Epidemiology and outcome of zygomycosis: a review of 929 reported cases. Clin Infect Dis. 2005;41(5):634-53. DOI: https://doi.org/10.1086/432579
Tedder M, Spratt JA, Anstadt MP, Hegde SS, Tedder SD, Lowe JE. Pulmonary mucormycosis: results of medical and surgical therapy. Ann Thorac Surg. 1994;57(4):1044-50. DOI: https://doi.org/10.1016/0003-4975(94)90243-7
Jung J, Kim MY, Lee HJ, Park YS, Lee SO, Choi SH, et al. Comparison of computed tomographic findings in pulmonary mucormycosis and invasive pulmonary aspergillosis. Clin Microbiol Infect. 2015;21(7):684.e11-8. DOI: https://doi.org/10.1016/j.cmi.2015.03.019
Wahba H, Truong MT, Lei X, Kontoyiannis DP, Marom EM. Reversed halo sign in invasive pulmonary fungal infections. Clin Infect Dis. 2008;46(4):1733-7. DOI: https://doi.org/10.1086/587991
Kim SH, Ha YE, Youn JC, Park JS, Sung H, Kim MN, et al. Fatal outcomes of disseminated mucormycosis in patients with hematologic malignancies despite antifungal therapy. J Infect Chemother. 2015;21(12):856-61.
Cornely OA, Alastruey-Izquierdo A, Arenz D, Chen SCA, Dannaoui E, Hochhegger B, et al. Global guideline for the diagnosis and management of mucormycosis: an initiative of the European Confederation of Medical Mycology in cooperation with the Mycoses Study Group Education and Research Consortium. Lancet Infect Dis. 2019;19(12):405-21. DOI: https://doi.org/10.1016/S1473-3099(19)30312-3
Arvanitis M, Ziakas PD, Zacharioudakis IM, Zervou FN, Caliendo AM, Mylonakis E. PCR in diagnosis of invasive aspergillosis: a meta-analysis of diagnostic performance. J Clin Microbiol. 2014;52(10):3731-42. DOI: https://doi.org/10.1128/JCM.01365-14
Walsh TJ, Anaissie EJ, Denning DW, Herbrecht R, Kontoyiannis DP, Marr KA, et al. Treatment of aspergillosis: clinical practice guidelines of the Infectious Diseases Society of America. Clin Infect Dis. 2008;46(3):327-60. DOI: https://doi.org/10.1086/525258
Marty FM, Ostrosky-Zeichner L, Cornely OA, Mullane KM, Perfect JR, Thompson GR 3rd, et al. Isavuconazole treatment for mucormycosis: a single-arm open-label trial and case-control analysis. Lancet Infect Dis. 2016;16(7):828-37. DOI: https://doi.org/10.1016/S1473-3099(16)00071-2
Prakash H, Chakrabarti A. Global epidemiology of mucormycosis. J Fungi (Basel). 2019;5(1):26. DOI: https://doi.org/10.3390/jof5010026
Downloads
Published
How to Cite
Issue
Section
