Mucormycosis of the bronchial anastomosis: a case of successful medical treatment and historic review.
Rhizomucor is a genus of zygomycetes that can cause pulmonary mucormycosis. In the immunocompromised host, mucormycosis was fatal until advances in anti-fungal therapy were combined with surgery. Although uncommon, fungal infection at the bronchial anastomosis is associated with a significant risk of morbidity and mortality after lung transplantation. Our patient is a middle-aged woman with end-stage chronic obstructive pulmonary disease who received a bilateral lung transplant. After discharge, she developed increasing dyspnea. Bronchoscopy revealed stenosis and Rhizomucor at the right anastomosis. Repeated endobronchial debridement, systemic lipid-soluble amphotericin, and inhaled amphotericin successfully resolved the infection. The residual stenosis was treated with a self-expandable metal stent. At 3 months, the patient continues on inhaled amphotericin suppression therapy without sequelae. Anastomosis mucormycosis is a grave complication after lung transplantation. Without combination therapy of surgery and anti-fungal drugs, mortality has been exceedingly high. We present a case wherein endobronchial debridement and anti-fungal therapy were successful without surgery.
McGuire
Franklin R
FR
Division of Pulmonary and Critical Care, University of South Carolina, School of Medicine, Columbia, South Carolina 29203, USA. fmcguire@gw.mp.sc.edu <fmcguire@gw.mp.sc.edu>
Grinnan
Daniel C
DC
Robbins
Mark
M
D000280:Administration, Inhalation; D000666:Amphotericin B / Q000008:administration & dosage*; D000714:Anastomosis, Surgical; D000935:Antifungal Agents / Q000008:administration & dosage*; D001980:Bronchi / Q000382:microbiology / Q000601:surgery*; D001999:Bronchoscopy; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016040:Lung Transplantation; D008875:Middle Aged; D009091:Mucormycosis / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology; D029424:Pulmonary Disease, Chronic Obstructive / Q000601:surgery; D020103:Rhizomucor / Q000302:isolation & purification*; D013530:Surgical Wound Infection / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology; D014057:Tomography, X-Ray Computed
D000935:Antifungal Agents; D000666:Amphotericin B