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Aspergillus and mucormycosis presenting with normal chest X-ray in an immunocompromised host

Vipin Gupta1, Natarajan Rajagopalan, Mahantesh Patil

  • 1Department of Pulmonology and Critical Care, Mazumdar Shaw Medical Center, Narayana Health, Bangalore, Karnataka, India.

BMJ Case Reports
|April 11, 2014
PubMed

Insights

This case report details a rare endobronchial coinfection of aspergillosis and mucormycosis in a diabetic patient. Early diagnosis via bronchoscopy is critical for invasive fungal infections in immunocompromised individuals.

Area of Science:

  • Medicine
  • Infectious Diseases
  • Pulmonology

Background:

  • Invasive fungal infections, including aspergillosis and mucormycosis, are significant threats to immunocompromised individuals.
  • Endobronchial fungal infections are documented, particularly in diabetic patients with ketoacidosis, but coinfection without pulmonary disease is rare.

Observation:

  • A diabetic patient presented with ketoacidosis, gastrointestinal symptoms, and respiratory distress, despite a normal chest X-ray.
  • CT scan revealed a cavitary lesion in the left lower lung lobe.
  • Bronchoscopy showed tracheal and bronchial mucosal edema and plaques, confirming endobronchial fungal presence.

Findings:

  • Microbiological and pathological analyses confirmed a coinfection with Aspergillus and Mucormycosis.
  • The patient's condition worsened despite aggressive treatment, leading to respiratory failure and death.

Implications:

  • This case highlights the importance of suspecting invasive fungal infections in immunocompromised patients with respiratory failure and subtle chest imaging findings.
  • Early fiberoptic bronchoscopy and prompt, aggressive treatment are crucial for improving survival rates in such critical cases.

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