Disseminated mucormycosis (DM) after pneumonectomy: a case report

Abstract

Background: Mucormycosis is a kind of rare opportunistic fungal disease and the incidence of which has gradually increased. Disseminated mucormycosis (DM) is a life-threatening infection that mostly occurs in immunocompromised patients. The lung and brain are usually involved in disseminated mucormycosis, and other sites are scare. We report the first case of disseminated mucormycosis whose infection sites included lung, skin, liver, vertebra, and spinal cord that ensued after a right lung pneumonectomy in an immunocompetent patient.

Case presentation: A 20-year-old female underwent a right lung pneumonectomy for "lung cancer" presented with an intermittent fever for two years. A computed tomography (CT) scan showed an enclosed outstanding mass in the right chest wall. The patient also suffered from lower limb numbness and weakness, difficulty walking, and dysuria. Medical examination showed superficial feeling of the abdominal wall was decreased from the T7 and T8 level; muscle strength for both lower limbs was decreased; muscle tension of both lower limbs was also diminished. A biopsy through the right chest wall mass and thoracic mass by fistula of chest wall showed broad nonseptate hyphae with right-angle branching, consistent with mucormycosis. With titration of amphotericin B and its lipid complex, the patient recovered.

Conclusions: Our case showed an unusual clinical presentation of disseminated mucormycosisin an immunocompetent patient.

Keywords: Case report; Disseminated mucormycosis; Immunocompetent; Pneumonectomy.

Fig. 1

The computed tomography (CT) scan showed an enclosed outstanding mass in the right chest wall 7-month later after the right lung resection

Fig. 2

Thoracic swelling with a protruding mass from the right chest wall was observed. The central part of the pack was a 0.3-cm-diameter fistula, which oozed a nonodorous, yellowish turbid liquid

Fig. 3

Results of CT and MRI (January 2015) for the chest. The CT shows a soft tissue mass (12.5 cm × 5.9 cm) around a small pneumatosis in the right chest wall, and a reduced density in the right liver lobe near the diaphragmatic top (a). The MRI shows lesions invaded the spinal channel and spinal cord (b)

Fig. 4

Histopathology showed broad nonseptate hyphae with right-angle branching, a (HE × 400), b (PAS × 400) and (c) (silver impregnation × 400)