A rare case of pulmonary mucormycosis and broncho‐esophageal fistula in a patient with poorly controlled diabetes

Autor: Farid Poursadegh, Safieh Shazdeh Ahmadi, Zahra Oskouyan, Mohammad Mahdi Alvandi Fard, Fariba Rezaeetalab, Mahnaz Mozdorian, Reza Basiri
Jazyk: angličtina
Rok vydání: 2024
Předmět:
Zdroj: Clinical Case Reports, Vol 12, Iss 7, Pp n/a-n/a (2024)
Druh dokumentu: article
ISSN: 2050-0904
DOI: 10.1002/ccr3.9093
Popis: Key Clinical Message In patients with poorly controlled diabetes, early recognition of rare fungal infections like pulmonary mucormycosis, especially when presenting with unusual complications such as broncho‐esophageal fistula, is critical. Prompt intervention with antifungal therapy and consideration for surgical debridement significantly impact outcomes. Multidisciplinary management is paramount for such complex cases. Abstract Mucormycosis is a rare fungal infection caused by the Mucorales. This infection is mostly observed among those with poorly controlled diabetes or immunodeficiency. The most common presentation of the infection among those with poorly controlled diabetes is rhino‐orbit‐cerebral involvement. In this case report, we provide the history and outcome of a rare case of pulmonary mucormycosis in a patient with poorly controlled diabetes who was simultaneously diagnosed with broncho‐esophageal fistula. Our patient was a 32‐year‐old male with a history of poorly controlled diabetes. Over the months, he had complained of productive coughs and dyspnea, which had lately been joined by dysphagia. He also claimed to have lost considerable weight (10 kg) during the previous 3 months. Barium swallow showed an abnormal flow of contrast between the bronchus and esophagus, suggesting a broncho‐esophageal fistula. Computed tomography of the thorax revealed a broncho‐esophageal fistula between the left main bronchus (LMB) and esophagus. He had a bronchoscopy the next day, which revealed necrosis and a broncho‐esophageal fistula in the LMB. A bronchial biopsy showed typical hyphae with necrotic tissue, indicating mucormycosis. The patient's antimycotic medication (liposomal amphotericin) was started and a prompt surgery consult was ordered. The patient, however, passed away from massive hemoptysis. We described a rare case of pulmonary mucormycosis with broncho‐esophageal fistula in a patient with poorly controlled diabetes. The rarity of this combination highlights the associated diagnostic and treatment hurdles. Early detection, antifungal medication, as soon as possible surgical debridement of involved tissues, and a multidisciplinary approach could improve patient outcomes.
Databáze: Directory of Open Access Journals
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