A rapidly progressing Pancoast syndrome due to pulmonary mucormycosis: a case report

Abstract

IntroductionPancoast syndrome is characterized by Horner syndrome, shoulder pain radiating down the arm, compression of the brachial blood vessels, and, in long-standing cases, atrophy of the arm and hand muscles. It is most commonly associated with lung carcinoma but rarely is seen with certain infections.Case presentationWe present the case of a 51-year-old Caucasian man who had acute myeloid leukemia and who developed a rapidly fulminating pneumonia along with signs and symptoms of acute brachial plexopathy and left Horner syndrome. Also, a purpuric plaque developed over his left chest wall and progressed to skin necrosis. The skin biopsy and bronchoalveolar lavage showed a Rhizopus species, leading to a diagnosis of mucormycosis. This is a rare case of pneumonia due to mucormycosis associated with acute Pancoast syndrome.ConclusionsAccording to our review of the literature, only a few infectious agents have been reported to be associated with Pancoast syndrome. We found only three case reports of mucormycosis associated with acute Pancoast syndrome. Clinicians should consider mucormycosis in their differential diagnosis in a patient with pulmonary lesions and chest wall invasion with or without neurological symptoms, especially in the setting of neutropenia or other immunosuppressed conditions. It is important to recognize this condition early in order to target therapy and interventions.

Pancoast’s Syndrome due to Fungal Abscess in the Apex of Lung in an Immunocompetent Individual: A Case Report and Review of the Literature

“…Immunosuppressed patients (diabetes, HIV infection, congenital immunodeficiency, postchemotherapy, neutropenia, etc.) are susceptible to invasive fungal infections which may cause Pancoast's syndrome due to direct or vascular invasion of bones, soft tissues, and nerves at thoracic inlet [ 10 ]. But, surprisingly, in our case bilateral apical Aspergillus abscesses were seen of which the left one was producing Pancoast's syndrome without any evidence of immunosuppression.…”

Pulmonary mucormycosis mimicking lung tumour in an uncontrolled diabetic patient

“…4 Patients who have dysfunctional cellular immunity, such as those who have had a stem cell transplant, leukaemia, uncontrolled diabetes, a solid organ transplant, neutropenia, corticosteroid and deferoxamine therapy, are more likely to develop infection. 2,5 The clinical signs and radiological findings of this infection are non-specific and very similar to other lung diseases. 6 The most common symptoms of pulmonary mucormycosis include fever, dyspnoea and productive cough.…”

Pulmonary mucormycosis: A case report and review of the literature

“…The symptoms of pulmonary mucormycosis are typically non-specific, even at late stages of infection, and may include fever, dyspnea, coughing and chest pain. Rare cases can present as progressive subcutaneous emphysema, Pancoast syndrome, Horner's syndrome, or chronic mediastinitis and bronchial perforation ( 7 , 14 – 17 ).…”