Abstract
To the Editor: Mucormycosis is a life-threatening infection that occurs predominantly in diabetic or immunosuppressed patients. Successful treatment requires early diagnosis, prompt antifungal therapy, and surgical debridement. We describe a patient with severe relapsing Wegener’s granulomatosis (WG), with pulmonary mucormycosis mimicking vasculitic disease relapse, successfully treated with combined posaconazole and amphotericin. A 29-year-old man was diagnosed with WG on the basis of a lung biopsy and a positive antineutrophil cytoplasm antibody (ANCA), who had presented with lung hemorrhage and transient acute renal failure. Plasmapheresis, steroids, and cyclophosphamide were administered, with complete recovery of renal and pulmonary function. He was maintained on azathioprine and prednisolone for 3 years, but subsequently developed a relapsing-remitting disease pattern. Over 2 years he had 4 relapses, with sinusitis, pulmonary nodules, and subglottic stenosis. He was initially treated with mycophenolate mofetil and prednisolone, while subsequent relapses required use of cyclophosphamide, infliximab, and finally rituximab. This resulted in successful disease remission and he was again maintained on low-dose azathioprine and prednisolone. He remained persistently ANCA-positive throughout his followup. Seven …
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