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• W4387251027 abstract "SESSION TITLE: Chest Infections Case Report Posters 10 SESSION TYPE: Case Report Posters PRESENTED ON: 10/09/2023 02:10 pm - 02:55 pm INTRODUCTION: Pulmonary mucormycosis is a rare infection that usually affects immunosuppressed patients with hematologic malignancies. Spore inhalation results in a rapidly progressive infection leading to pulmonary necrosis and infarct. For patients with pulmonary involvement, mortality rates approach 50%. The most common fungi to cause fatal disease is the genus Rhizopus. Diabetes mellitus is a common risk factor in rhino-orbital-cerebral infections, but less common in pulmonary manifestations. We present a case of pulmonary mucormycosis in a patient with uncontrolled type 2 diabetes mellitus. CASE PRESENTATION: A 63-year-old male with type 2 diabetes mellitus presented to our hospital with right sided chest pain with radiation to the back, non-productive cough, and night sweats. Vital signs were within normal limits. Serological evaluation demonstrated a white blood cell count of 14.2 K/uL, blood glucose of 610 mg/dL, and procalcitonin of 0.12 ng/mL. He was found to have a hemoglobin A1C level of 14.3%. Chest radiographs showed a mass-like consolidation within the right upper lobe with follow-up computed tomography (CT) revealing an 8.4 x 7.1 cm mass with 3.2 x 2.9 cm central cavitation. He was admitted to the hospital and started on broad spectrum antibiotics along with fluconazole. The patient underwent bronchoscopy with bronchoalveolar lavage (BAL) and fluoroscopic transbronchial biopsies. Extensive infectious workup was negative along with BAL cultures and histopathology of biopsies. Due to negative work-up, he was discharged on oral levofloxacin and metronidazole for two weeks for what was thought to be cavitary pneumonia from chronic aspiration. He re-presented to the hospital after completion of these antibiotics with persistent symptoms. Repeat CT revealed progression of the cavitary mass, increasing to 10 x 7.4 cm. Repeat bronchoscopy was performed along with BAL and transbronchial biopsies. Biopsy histopathology now revealed branching septate hyphae with necrotic debris, with morphology favoring aspergillus as the etiology. The patient was switched to voriconazole for treatment and was discharged. One week later, BAL cultures returned positive for Rhizopus species. The patient was admitted to the hospital for liposomal amphotericin b initiation and surgical debridement. He successfully underwent right posterolateral thoracotomy and right upper lobectomy with partial decortication. Pathology of the lobectomy demonstrated a cystic cavity with acute inflammation and abundant of broad non-septate fragmented fungal hyphae compatible with mucormycosis fungus. The patient was discharged with an extended course of liposomal amphotericin b treatment. DISCUSSION: Pulmonary mucormycosis rarely manifests in patients with diabetes mellitus and is challenging to diagnose accurately and rapidly. Our patient was ultimately diagnosed only after two invasive bronchoscopies with accompanying histopathology sampling (without molecular detection capabilities), multiple failed therapies, and a prolonged duration for speciation of cultures. This overall delay in diagnosis likely contributes to the high morality in patients with this infection, particularly if their presenting symptom is hemoptysis. Appropriate urgent management after diagnosis should include early medical treatment with antifungals and surgical debridement of tissue, as was performed in our case. CONCLUSIONS: In patients with diabetes mellitus and cavitary pulmonary masses, pulmonary mucormycosis should be considered early as delay in treatment could be fatal. REFERENCE #1: Novais AG, Capelo J, Costa M, Conceição M, Crespo P, Mocho L, Leão B, Malheiro L, Silva S, Sarmento A. Pulmonary mucormycosis: A case report. IDCases. 2020 Nov 1;22:e00993. REFERENCE #2: Lee FY, Mossad SB, Adal KA. Pulmonary mucormycosis: the last 30 years. Arch Intern Med. 1999 Jun 28;159(12):1301-9. REFERENCE #3: Tedder M, Spratt JA, Anstadt MP, Hegde SS, Tedder SD, Lowe JE. Pulmonary mucormycosis: results of medical and surgical therapy. Ann Thorac Surg. 1994 Apr;57(4):1044-50. DISCLOSURES: No relevant relationships by Christopher Dossett No relevant relationships by Esa Rayyan No relevant relationships by Miriam Robin" @default.
• W4387251027 created "2023-10-03" @default.
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• W4387251027 date "2023-10-01" @default.
• W4387251027 modified "2023-10-03" @default.
• W4387251027 title "A CASE OF PULMONARY MUCORMYCOSIS IN AN UNCONTROLLED DIABETIC" @default.
• W4387251027 doi "https://doi.org/10.1016/j.chest.2023.07.839" @default.
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