Abstract
Invasive pulmonary mucormycosis and aspergillosis are rare, life-threatening fungal infections. Most documented cases have been reported in non-cirrhotic patients with diabetes mellitus, neutropenia, or treatment with corticosteroids. The prevalence of each infection is low among patients with hepatic cirrhosis. We report the first likely case of combined invasive pulmonary mucormycosis and aspergillosis in a male with decompensated hepatic cirrhosis. This report also highlights the first non-diabetic case of invasive pulmonary mucormycosis with decompensated hepatic cirrhosis.
Highlights
Mucormycosis and Aspergillosis are rare, life-threatening fungal infections with mortality rates reported to be over 50% despite surgical debridement and antifungal therapy [1,2]
The data indicate that this patient had both invasive pulmonary mucormycosis and aspergillosis
The diagnosis of mucormycosis was made by the isolation of R. arrhizus from cultures of the bronchoalveolar lavage (BAL) fluid and chest tube insertion site, and the finding of broad non-septate hyphae on the BAL cytology specimen
Summary
Mucormycosis and Aspergillosis are rare, life-threatening fungal infections with mortality rates reported to be over 50% despite surgical debridement and antifungal therapy [1,2]. The patient was taken to the operating room where a right above-the-knee amputation was performed for his necrotizing soft tissue infection on day 0. On day+ 10, given the continued refractory septic shock and bibasilar patchy infiltrates seen on CXR, a bronchoalveolar lavage (BAL) was performed, and thick frothy respiratory secretions with pus were seen. On day+ 16, a repeat CT scan of the chest revealed worsening of right lung patchy infiltrates (Fig. 1B). A rapidly growing mold grew in cultures of both the BAL sample and a swab from the right chest tube site; the specimens were sent to an outside reference laboratory for identification. The rapidly growing mold from the BAL and right chest tube insertion site was identified as R. arrhizus, indicating the presence of invasive pulmonary mucormycosis
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