Mucormycosis of the bronchial anastomosis: a case of successful medical treatment and historic review

Abstract

Rhizomucor is a genus of zygomycetes that can cause pulmonary mucormycosis. In the immunocompromised host, mucormycosis was fatal until advances in anti-fungal therapy were combined with surgery. Although uncommon, fungal infection at the bronchial anastomosis is associated with a significant risk of morbidity and mortality after lung transplantation. Our patient is a middle-aged woman with end-stage chronic obstructive pulmonary disease who received a bilateral lung transplant. After discharge, she developed increasing dyspnea. Bronchoscopy revealed stenosis and Rhizomucor at the right anastomosis. Repeated endobronchial debridement, systemic lipid-soluble amphotericin, and inhaled amphotericin successfully resolved the infection. The residual stenosis was treated with a self-expandable metal stent. At 3 months, the patient continues on inhaled amphotericin suppression therapy without sequelae. Anastomosis mucormycosis is a grave complication after lung transplantation. Without combination therapy of surgery and anti-fungal drugs, mortality has been exceedingly high. We present a case wherein endobronchial debridement and anti-fungal therapy were successful without surgery.