Mucormycosis is a rare complication in immunocompromised patients. Antemortem diagnosis of mucormycosis is difficult and often incorrect. We report a case of pulmonary mucormycosis caused by Cunninghamella bertholletiae in an elderly man with interstitial pneumonia. The diagnosis of mucormycosis was established by bronchoalveolar lavage. A coexisting immune deficiency condition was considered. Lung cancer was suspected because of an elevated progastrin-releasing peptide level and bilateral hilar and mediastinal lymphadenopathy; it was diagnosed after performing endoscopic ultrasound-guided fine-needle aspiration. Treatment by intravenous liposomal amphotericin B was effective, but relapse occurred because of bone marrow suppression caused by chemotherapy for lung cancer. Treatment for mucormycosis was resumed, but the patient died of carcinomatous lymphangiosis. Autopsy confirmed the diagnosis of pulmonary mucormycosis and revealed refractory anaemia with small cell lung cancer. Mucormycosis often occurs in immunocompromised patients, but this case is rare because the mucormycosis was diagnosed before the diagnosis of malignancy. Because prognosis is often poor, the possibility of coexisting malignancies should always be investigated in patients with mucormycosis infections.
IntroductionMucormycosis is a rare but opportunistic fungal infection that occurs in immunocompromised patients. Its antemortem diagnosis is especially difficult. Mucormycosis often carries a poor prognosis, which is particularly poor when the disease is caused by Cunninghamella species (Roden et al., 2005). We report a case of pulmonary Cunninghamella infection with lung cancer and refractory anaemia. Lung cancer was diagnosed after the diagnosis of pulmonary mucormycosis, and refractory anaemia was revealed by autopsy. This is a rare case because mucormycosis was diagnosed before diagnosing the malignancy. The possibility of coexisting malignancies should be investigated without fail in patients with mucormycosis infections.
Case reportA 74-year-old Japanese man with interstitial pneumonia (IP) and pulmonary emphysema, for which no medication had been administered, was admitted with fever, cough and exertional dyspnoea. His haemoglobin A1c levels had recently increased to 6.5 % National Glycohemoglobin Standardization Program (NGSP) derived units [47.2 mmol mol
21, International Federation of Clinical Chemists' (IFCC) units], but he was not treated for diabetes mellitus. His medical history was significant for previous myocardial infarction, angina pectoris and chronic heart failure. He was a 60-pack-year ex-smoker living in a 70-year-old wooden house and managed a metal-recycling company; thus, he was exposed to fine metal particles. On admission, his vital signs were stable, with ambient oxygen saturation of 94 %. Auscultation revealed a few fine crackles bilaterally in the lower lung fields and coarse crackles in the right upper lung field. The complete blood count was normal. His C-reactive protein level was 3.4 mg dl 21 and his KL-6 w...