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Case Reports
. 2021 Jan 25;9(3):e00712.
doi: 10.1002/rcr2.712. eCollection 2021 Mar.

The reverse halo sign and spontaneous pneumothorax due to pulmonary mucormycosis

Muhammad Umair Khawar  1 , Maida Tiwana  2 , Ruchira Sengupta  3 , Jiang Wang  4 , Veronica Indihar  1
Affiliations
Case Reports

The reverse halo sign and spontaneous pneumothorax due to pulmonary mucormycosis

Muhammad Umair Khawar et al. Respirol Case Rep. .

Abstract

Pulmonary mucormycosis (PM) is a rare opportunistic fungal infection that commonly affects immunocompromised patients. Early diagnosis and initiation of appropriate anti-fungal therapy are crucial, as delay in diagnosis leads to increased mortality. However, the diagnosis is often challenging because of the lack of utility of serum markers and low culture sensitivity. Definitive diagnosis often requires invasive tissue sampling, which may delay treatment. Therefore, chest imaging findings play an important role in the diagnosis of suspected cases. This case highlights the importance of classic reverse halo sign and presence of necrotizing cystic changes resulting in spontaneous pneumothorax in a patient who was later found to have invasive PM.

Keywords: Mucormycosis; reverse halo sign; spontaneous pneumothorax.

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Figures

Figure 1
Figure 1
Axial computed tomography (CT) chest image with large cystic area and ground‐glass opacification, surrounded by crescent of dense consolidation on the left (black arrow).
Figure 2
Figure 2
Coronal computed tomography (CT) chest image with large left‐sided area of central ground glass surrounded by crescent of dense consolidation, described as reverse halo sign (black arrow).
Figure 3
Figure 3
Histopathology of lung in autopsy. (A, C) Haematoxylin and eosin (H&E) stain; (B, D) Grocott methenamine silver (GMS) stain. (A) Severe acute pneumonia with lung parenchymal haemorrhage and necrosis; (C) Fungi invading vessel wall (black arrow); GMS stain demonstrates abundant fungal elements invading lung parenchyma (B) and vessel wall (D, red arrows).
See this image and copyright information in PMC

References

    1. Pilmis B, Alanio A, Lortholary O, et al. 2018. Recent advances in the understanding and management of mucormycosis. F1000Res. 7:F1000 Faculty Rev‐1429. 10.12688/f1000research.15081.1 - DOI - PMC - PubMed
    1. Hammer MM, Madan R, and Hatabu H. 2018. Pulmonary mucormycosis: radiologic features at presentation and over time. Am. J. Roentgenol. 210(4):742–747. - PubMed
    1. Jung J, Kim M, Lee H, et al. 2015. Comparison of computed tomographic findings in pulmonary mucormycosis and invasive pulmonary aspergillosis. Clin. Microbiol. Infect. 21(7):684.e11–684.e18. - PubMed
    1. Movahed MM, Hosamirudsari H, Mansouri F, et al. 2015. Spontaneous pneumothorax followed by reversed halo sign in immunocompromised patient with pulmonary mucormycosis. Med. Mycol. Case Rep. 9:22–25. - PMC - PubMed
    1. Nagakawa H, Igar H, Konishi K, et al. 2013. An autopsy case of tension pneumothorax due to the rupture of intrapulmonary cavity by mucormycosis during treatment with a ventilator. Med. Mycol. J. 54(3):285–289. - PubMed

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