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Zygomycotic lung abscess: a case report
1Department of Internal Medicine, Veterans General Hospital-Kaohsiung, Kaohsiung, Taiwan, R.O.C.
Abstract:
Zygomycosis is an uncommon, but frequently fatal, fungal infection caused by members of the class Zygomycetes. The risk factors include diabetes mellitus, uremia, leukemia and use of deferoxamine as an iron-chelating agent; healthy persons also are occasionally infected. Those fungi, spread by their ubiquitous spores, most frequently involve the respiratory system. Rhinocerebral zygomycosis occurs predominantly in patients with uncontrolled diabetic ketoacidosis. Pulmonary zygomycosis most frequently is observed in granulocytopenic and corticosteroid-treated patients. Other clinical manifestations are gastrointestinal, cutaneous, disseminated and miscellaneous. This report concerns a previously robust farmer who suffered from left upper lung abscess caused by Rhizopus spp.-one member of the order Mucorales. Initially, it was intended to administer amphotericin B to a total dose of 2,000 mg; however, the patient could not tolerate such side effects as nausea, vomiting and refused further management when the cumulative dose was 948 mg. However, he did recover without further fever and cough. Chest X-ray, followed every three months, disclosed satisfactory improvement.
Insights
Zygomycosis, a rare fungal infection, can be fatal. This case highlights a lung abscess caused by Rhizopus spp. in a healthy individual, successfully treated with reduced amphotericin B dosage.
Area of Science:
- Mycology
- Infectious Diseases
Background:
- Zygomycosis is a severe fungal infection caused by Zygomycetes, often fatal.
- Risk factors include diabetes mellitus, uremia, leukemia, and deferoxamine use.
- Pulmonary zygomycosis commonly affects immunocompromised patients, such as those with granulocytopenia or on corticosteroids.
Observation:
- This report details a case of a previously healthy farmer with a left upper lung abscess.
- The abscess was caused by Rhizopus spp., a fungus belonging to the order Mucorales.
- The patient received 948 mg of amphotericin B but could not tolerate the planned 2,000 mg due to side effects.
Findings:
- Despite incomplete treatment, the patient recovered without fever or cough.
- Chest X-rays showed satisfactory improvement over three months.
Implications:
- This case suggests that successful outcomes for pulmonary zygomycosis may be achievable with reduced amphotericin B dosages in select patients.
- It underscores the importance of considering zygomycosis even in seemingly healthy individuals.
- Further research into optimal treatment durations and dosages for zygomycosis is warranted.