Successful treatment of mixed pulmonary Aspergillus and Mucor infection using intrabronchial amphotericin B infusion: a case report and literature review

Abstract

Background: Reports of pulmonary aspergillosis and mucormycosis co-infections are rare; thus, limited guidance is available on early diagnosis and treatment. We present a case of mixed pulmonary Aspergillus and Mucor infection and review the literature regarding this co-infection. The diagnosis and treatment methods are summarized to improve clinicians' understanding of the disease and to facilitate early diagnosis and treatment.

Case presentation: A 60-year-old male farmer with poorly controlled diabetes mellitus was admitted to hospital with a fever of unknown origin that had been present for 15 days and pulmonary aspergillosis complicated by Mucor spp.

Infection: Because multiple lobes were involved, the infection worsened despite surgical resection and antifungal therapy. Finally, we treated this patient with a bronchoscopic infusion of amphotericin B. After four courses of bronchoscopic amphotericin B infusion, we observed rapid clinical improvement and subsequent resolution of pulmonary infiltrates.

Conclusion: Our case highlights the use of bronchoscopy in the successful clinical treatment of invasive fungal diseases of the lung.

Keywords: Amphotericin B; Bronchoscopic treatment; Invasive fungal infections; Pulmonary aspergillosis; Pulmonary mucormycosis.

Fig. 1

Chest computed tomography (CT) (a, b) before starting treatment showing high-density shadows in both lungs and patchy, crescent-shaped low-density gas shadows in the lesions. (c) Chest CT taken 3.5 months later before starting bronchoscopic intramucosal liposomal amphotericin B treatment showing a slightly larger lesion in the right upper lobe of the lung. (d) Chest CT reexamination after 4 treatment courses showing obvious absorption of the lesion in the patient’s right lung

Fig. 2

Hyphae of Mucor and Aspergillus observed on periodic acid-Schiff stain of lung biopsy samples (40×)