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Mucormycosis masquerading as an endobronchial tumor.

Mahajan R, Paul G, Chopra P, Suri P - Lung India (2014)

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine, Dayanand Medical College and Hospital, Ludhiana, India.

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Sir, A 58-year-old woman with poorly controlled diabetes mellitus presented with a 2-week history of high grade fever with rapidly progressive shortness of breath 1 day prior to admission... She was a known case of dilated cardiomyopathy and diabetic nephropathy... Systemic examination revealed tachypnea, decreased breath sounds bilaterally with basal rales, decreased intensity of heart sounds and audible S3, tender hepatomegaly with fluid thrill... The patient was started on liposomal amphoterecin and surgical resection of upper lobe was planned, but patient's condition deteriorated... Nearly, 78% of patients of pulmonary mucormycosis can have an acute presentation and our patient had a very rapidly progressive clinical course as well... However, unfortunately the recovery of fungi from culture is less sensitive due to hyphal damage during processing of the specimen... Hence, it has been agreed that microscopic identification of characteristic fungi invading affected tissues should be considered significant [Figure 4]... Massive hemoptysis may be due to vascular invasion, multiple pulmonary artery pseudoaneurysms and can lead to death due to asphyxiation... Patients on medical therapy alone have a mortality of 55% compared to 27% in patients who get surgical treatment with or without medical treatment... Surgical therapy is highly recommended and must be performed without delay because of the aggressive nature of the disease with propensity for vascular invasion... We managed our patient conservatively and planned for lobectomy, but she developed multi-organ failure and did not give time for surgery... In conclusion, pulmonary mucormycosis is a rare, rapidly spreading disease and fatal disease, which can masquerades many common conditions including lung cancer.

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Microphotograph of histopathology section from the lesion (hematoxylin-eosin stain) shows broad aseptate hyphae with frequent right-angle branching suggestive of mucormycosis
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Figure 4: Microphotograph of histopathology section from the lesion (hematoxylin-eosin stain) shows broad aseptate hyphae with frequent right-angle branching suggestive of mucormycosis

Mentions: It was on ninth hospital day that she again became febrile and her chest X-ray revealed left upper lobe collapse [Figure 2]. Her oxygen requirement increased, she was intubated and put on mechanical ventilator. Computed tomography (CT) of the chest revealed heterogeneous mass measuring 5.3 × 3.2 cm in the left hilum, completely obliterating the left upper lobe [Figure 3]. Fiberoptic bronchoscopy revealed reddish polypoidal growth causing almost complete obstruction of left upper lobe bronchus. Histopathology examination of the bronchial biopsy showed irregular broad aseptate hyphae branching at right angles, consistent with mucormycosis. [Figure 4]. The patient was started on liposomal amphoterecin and surgical resection of upper lobe was planned, but patient's condition deteriorated. She developed multi-organ failure and had massive hemoptysis followed by cardiac arrest and succumbed to treatment on the 24th day of hospitalization.


Mucormycosis masquerading as an endobronchial tumor.

Mahajan R, Paul G, Chopra P, Suri P - Lung India (2014)

Microphotograph of histopathology section from the lesion (hematoxylin-eosin stain) shows broad aseptate hyphae with frequent right-angle branching suggestive of mucormycosis
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4129617&req=5

Figure 4: Microphotograph of histopathology section from the lesion (hematoxylin-eosin stain) shows broad aseptate hyphae with frequent right-angle branching suggestive of mucormycosis
Mentions: It was on ninth hospital day that she again became febrile and her chest X-ray revealed left upper lobe collapse [Figure 2]. Her oxygen requirement increased, she was intubated and put on mechanical ventilator. Computed tomography (CT) of the chest revealed heterogeneous mass measuring 5.3 × 3.2 cm in the left hilum, completely obliterating the left upper lobe [Figure 3]. Fiberoptic bronchoscopy revealed reddish polypoidal growth causing almost complete obstruction of left upper lobe bronchus. Histopathology examination of the bronchial biopsy showed irregular broad aseptate hyphae branching at right angles, consistent with mucormycosis. [Figure 4]. The patient was started on liposomal amphoterecin and surgical resection of upper lobe was planned, but patient's condition deteriorated. She developed multi-organ failure and had massive hemoptysis followed by cardiac arrest and succumbed to treatment on the 24th day of hospitalization.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine, Dayanand Medical College and Hospital, Ludhiana, India.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

Sir, A 58-year-old woman with poorly controlled diabetes mellitus presented with a 2-week history of high grade fever with rapidly progressive shortness of breath 1 day prior to admission... She was a known case of dilated cardiomyopathy and diabetic nephropathy... Systemic examination revealed tachypnea, decreased breath sounds bilaterally with basal rales, decreased intensity of heart sounds and audible S3, tender hepatomegaly with fluid thrill... The patient was started on liposomal amphoterecin and surgical resection of upper lobe was planned, but patient's condition deteriorated... Nearly, 78% of patients of pulmonary mucormycosis can have an acute presentation and our patient had a very rapidly progressive clinical course as well... However, unfortunately the recovery of fungi from culture is less sensitive due to hyphal damage during processing of the specimen... Hence, it has been agreed that microscopic identification of characteristic fungi invading affected tissues should be considered significant [Figure 4]... Massive hemoptysis may be due to vascular invasion, multiple pulmonary artery pseudoaneurysms and can lead to death due to asphyxiation... Patients on medical therapy alone have a mortality of 55% compared to 27% in patients who get surgical treatment with or without medical treatment... Surgical therapy is highly recommended and must be performed without delay because of the aggressive nature of the disease with propensity for vascular invasion... We managed our patient conservatively and planned for lobectomy, but she developed multi-organ failure and did not give time for surgery... In conclusion, pulmonary mucormycosis is a rare, rapidly spreading disease and fatal disease, which can masquerades many common conditions including lung cancer.

No MeSH data available.


Related in: MedlinePlus