A Rare Case of Fatal Endobronchial Mucormycosis Masquerading as Endobronchial Tuberculosis

Abstract

Pulmonary mucormycosis is a relatively rare but often fatal opportunistic fungal infection that occurs mostly in immunocompromised patients. Endobronchial mucormycosis, a distinct clinical form of pulmonary mucormycosis, is very rare, and only a few cases have been reported. The most common bronchoscopic findings in patients with endobronchial mucormycosis are stenosis, erythematous mucosa and airway obstruction. Here, we present a case of fatal endobronchial mucormycosis mimicking actively caseating endobronchial tuberculosis in a young diabetic patient living in a country with an intermediate tuberculosis burden.

Pulmonary and Extrapulmonary Manifestations of Fungal Infections Misdiagnosed as Tuberculosis: The Need for Prompt Diagnosis and Management

“…They are ubiquitous and predominantly found in the soil or decaying organic matter. Infection usually occurs via the inhalation of spores with pulmonary forms occasionally mimicking the clinical presentation of pulmonary TB and may be misdiagnosed as such [ 61 , 62 , 63 , 64 ]. Usually, pulmonary mucormycosis is an acute or subacute infection, with a poor outcome, but occasionally it can be a chronic disease process.…”

“…Mucormycosis should therefore be considered in patients with suspected TB, especially when there is no improvement with anti-tuberculous therapy in patients with risk factors outlined above. Mortality often occurs with delayed presentation and/or diagnosis [ 63 ]. Besides fatalities, economic losses and prolonged hospital stay are other challenges identified in the highlighted case reports and these were not unconnected with poor awareness and low index of suspicion on the part of clinicians [ 61 , 62 , 63 , 64 ].…”

“…Mortality often occurs with delayed presentation and/or diagnosis [ 63 ]. Besides fatalities, economic losses and prolonged hospital stay are other challenges identified in the highlighted case reports and these were not unconnected with poor awareness and low index of suspicion on the part of clinicians [ 61 , 62 , 63 , 64 ]. We summarized four cases of pulmonary mucormycosis misdiagnosed as pulmonary tuberculosis; AFB/GeneXpert results were negative in two case patients and not stated in the other two cases, only one case was HIV positive, outcome was favorable in two cases, not revealed in one, while the other had fatal outcome ( Table 1 and Table 6 ).…”

Isolated tracheobronchial mucormycosis: Report of a case and systematic review of literature

“…Cases, where lung collapse was observed on chest radiograph along with an exophytic tracheal or central airway lesion, were also included if the radiograph normalised immediately after managing tracheal mucormycosis. We excluded cases with concomitant pulmonary parenchymal involvement or tracheal infiltration secondary to mucormycosis of the adjacent structures (such as laryngeal, pharyngeal, oesophageal, mediastinal structures or vascular aneurysmal rupture into the trachea) 4–9 . We also excluded cases with lobar or segmental bronchial involvement 10–12 .…”

“…We excluded cases with concomitant pulmonary parenchymal involvement or tracheal infiltration secondary to mucormycosis of the adjacent structures (such as laryngeal, pharyngeal, oesophageal, mediastinal structures or vascular aneurysmal rupture into the trachea). [4][5][6][7][8][9] We also excluded cases with lobar or segmental bronchial involvement. [10][11][12] We excluded conference abstracts, review articles and editorials.…”