Aspergillus and mucormycosis presenting with normal chest X-ray in an immunocompromised host.
Invasive aspergillus and mucormycosis infection are not uncommon in immunocompromised individuals. Endobronchial fungal infections have been reported in the literature, especially in patient's with diabetes complicated by diabetic ketoacidosis, but end bronchial coinfection with aspergillus and mucormycosis without pulmonary involvement has not been described in the literature. We report the case of a woman with diabetes who presented with gastrointestinal symptoms, ketoacidosis and respiratory distress, with an apparently normal chest X-ray. Investigations revealed a cavitatory lesion in the left lower lobe of the lungs on CT scan. Bronchoscopy revealed intense mucosal oedema and whitish plaques at the lower end of the trachea and right main stem bronchus with a normal left bronchial tree. Microbiological and pathological results confirmed aspergillus and mucormycosis. Despite aggressive medical management, the patient deteriorated and died of respiratory failure. Strong suspicion of invasive fungal infections in immunocompromised patients with respiratory failure and minimal chest infiltrates, early fibreoptic bronchoscopy and early aggressive treatment is crucial for the patient's survival.
Department of Pulmonology and Critical Care, Mazumdar Shaw Medical Center, Narayana Health, Bangalore, Karnataka, India.
Vipin
V
Gupta
Natarajan
N
Rajagopalan
Mahantesh
M
Patil
C
C
Shivaprasad
D001230:Aspergillus; D001980:Bronchi / Q000382:microbiology / Q000473:pathology; D001999:Bronchoscopy; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D016883:Diabetic Ketoacidosis / Q000150:complications*; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D008168:Lung / Q000000981:diagnostic imaging*; D008172:Lung Diseases, Fungal / Q000175:diagnosis* / Q000382:microbiology / Q000473:pathology; D008875:Middle Aged; D009091:Mucormycosis / Q000175:diagnosis* / Q000382:microbiology / Q000473:pathology; D012131:Respiratory Insufficiency / Q000175:diagnosis* / Q000209:etiology / Q000382:microbiology; D014057:Tomography, X-Ray Computed; D014132:Trachea / Q000382:microbiology / Q000473:pathology; D014965:X-Rays