Pulmonary mucormycosis diagnosed by convex probe endobronchial ultrasound-guided fine needle aspiration of cavity wall

Abstract

Pulmonary mucormycosis is an opportunistic fungal infection in immunocompromised individuals. It is difficult to diagnose as it requires tissue biopsy, and generally these patients are unfit to undergo invasive lung biopsies. We describe a novel technique in a case with uncontrolled diabetes mellitus with nonresolving pulmonary cavitary disease where convex probe endobronchial ultrasound (EBUS)-guided aspiration of lung cavity wall showed classical histopathological picture establishing the diagnosis of mucorale infection. EBUS being real-time, minimally invasive technique with minimal risk of complications, led to early diagnosis, and prompt treatment. This appears to be a novel diagnostic modality in pulmonary mucormycosis with minimal complications as compared with other biopsy methods with very high complication risk.

Keywords: Endobronchial ultrasound-guided fine needle aspiration; mucormycosis; pulmonary cavity.

Figure 1

(a and b) X-ray chest and computerized tomography scan of the chest showing thick walled large cavity in the right upper lobe, (b) site of endobronchial ultrasound scope placement in right secondary carina for localization of cavity wall (arrow). (c) Histopathology of cavity wall showing fungal colonies with aseptate, broad-based right-angled branching fungal hypha consistent with mucormycosis. (d) Repeat computerized tomography chest after 4 weeks showing marked reduction in size of the cavity as compared to computerized tomography chest shown in Figure 1b