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Case Reports
. 2013 Aug 20:2013:bcr2013009615.
doi: 10.1136/bcr-2013-009615.

Coinfection of pulmonary mucormycosis and aspergillosis presenting as bilateral vocal cord palsy

Arun H Mahadevaiah  1 , Natarajan Rajagopalan, Mahantesh Patil, Shivaprasad C
Affiliations
Case Reports

Coinfection of pulmonary mucormycosis and aspergillosis presenting as bilateral vocal cord palsy

Arun H Mahadevaiah et al. BMJ Case Rep. .

Abstract

Invasive pulmonary coinfection with Mucor and Aspergillus is rare. Bilateral vocal cord paralysis resulting from coinfection with these two fungi to our knowledge has not been reported in the literature. We report a young woman with diabetes who presented with symptoms of community acquired pneumonia in association with hoarseness of voice. Investigations revealed air space consolidation of the right upper lobe, evidence of mediastinal involvement extending into the paratracheal space and entrapment of right upper lobe pulmonary artery. Bronchoscopy revealed bilateral vocal cord paralysis and sloughing of mucosa of the right upper lobe bronchus and the bronchus intermedius. Microbiological and pathological results confirmed Mucor and Aspergillus. Extensive vascular and mediastinal involvement precludes surgical debridement. Despite aggressive medical management the patient deteriorated and died of respiratory failure. Strong suspicion of invasive fungal infections in immune compromised patients presenting with unresolving pneumonia and hoarseness of voice, early aggressive treatment is crucial for the patient survival.

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Figures

Figure 1
Figure 1
Chest X-ray showing right upper and mid zone air space consolidation on admission.
Figure 2
Figure 2
Mediastinal window (A) and lung window (B). CT thorax images showing right upper lobe dense consolidation with early cavitation along with mediastinal involvement and right upper lobe pulmonary artery occlusion.
Figure 3
Figure 3
Bronchoscopic image showing immobile vocal cords.
Figure 4
Figure 4
(A–C) Bronchoscopic images showing greyish white slough extending along the right main bronchus into the right middle lobe bronchus. (D) Biopsy taken from the endobronchial lesion.
Figure 5
Figure 5
Histopathological examination showing aseptate hyphae with right angled branching.
See this image and copyright information in PMC

References

    1. Lee FYW, Mossad SB, Adal KA. Pumonary mucormycosis : the last 30 years. Arch Intern Med 1999;2013:1301–9 - PubMed
    1. Fahimzad A, Chavoshzadeh Z, Abdollahpour H, et al. Necrosis of nasal cartilage due to mucormycosis in a patient with severe congenital neutropenia due to HAX1 deficiency. J Investig Allergol Clin Immunol 2008;2013:469–72 - PubMed
    1. Devlin SM, Hu B, Ippoliti A. Mucormycosis presenting as recurrent gastric perforation in a patient with Crohn's disease on glucocorticoid, 6-mercaptopurine, and infliximab therapy. Dig Dis Sci 2007;2013:2078–81 - PubMed
    1. Salinas-Lara C, Rembao-Bojórquez D, de la Cruz E, et al. Pituitary apoplexy due to mucormycosis infection in a patient with an ACTH producing pulmonary tumor. J Clin Neurosci 2008;2013:67–70 - PubMed
    1. Johnson KE, Leahy K, Owens C, et al. An atypical case of fatal zygomycosis: simultaneous cutaneous and laryngeal infection in a patient with a non-neutropenic solid prostatic tumor. Ear Nose Throat J 2008;2013:152–5 - PubMed

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