Primary mediastinal mucormycosis presenting with hoarseness: a case report

Area of Science:

• Mycology
• Infectious Diseases
• Pulmonology

Background:

• Mucormycosis is a rare, aggressive fungal infection caused by Mucorales molds, primarily affecting immunocompromised individuals.
• Mediastinal mucormycosis is exceptionally rare (<50 reported cases) with high mortality, often mimicking malignancies.
• Diagnostic challenges arise from nonspecific clinical and radiologic findings.

Purpose of the Study:

• To report a rare case of primary mediastinal mucormycosis presenting with hoarseness.
• To highlight diagnostic difficulties and successful nonsurgical management of this rare condition.

Main Methods:

• Case report of a 76-year-old man with chronic obstructive pulmonary disease and progressive hoarseness.
• Diagnostic imaging included contrast-enhanced chest computed tomography (CT).
• Diagnosis confirmed by CT-guided mediastinal biopsy revealing characteristic fungal hyphae; treatment involved intravenous amphotericin B followed by oral isavuconazole.

Main Results:

• Initial CT suggested lung carcinoma due to a mediastinal mass.
• Biopsy confirmed mucormycosis.
• Antifungal therapy led to significant lesion regression and symptomatic improvement within 6 months; surgery was not feasible.

Conclusions:

• Mediastinal mucormycosis should be considered in patients with atypical symptoms like hoarseness, especially those with chronic illnesses.
• Early diagnosis via tissue biopsy is crucial.
• Timely antifungal treatment is essential for a better prognosis in mediastinal mucormycosis.