Rare cause of pulmonary cavitation in a 75-year-old man

Characteristics of pulmonary mucormycosis and the experiences of surgical resection

Background

Pulmonary mucormycosis (PM) is a relatively rare but fatal infection. However, detailed surgery data have been lacking. We summarized the characteristics of this rare disease and clarified the experiences of surgical resection

Methods

We conducted a single-center retrospective study of seven patients with PM who underwent surgical resection at China-Japan Friendship Hospital from May 2011 to May 2018.

Results

Patient ages ranged from 18 to 70 years, with a median age of 47 years. Manual workers (85.7%) were the most common occupation and their educational level was also below high school. Diabetes was the most common underlying condition. The most common radiographic finding was lobar consolidation. Three patients directly underwent open thoracotomy, one patient underwent video-assisted thoracic surgery (VATS) and three patients converted from VATS to thoracotomy. The median operation time was 240 min [interquartile range (IQR), 150–390 min], the median intraoperative blood loss was 500 mL (IQR, 100–1,200 mL) and the median intraoperative blood transfusion was 600 mL (IQR, 0–1,600 mL). In-hospital, 90-day, 1-year and 5-year mortality were 14.3%, 14.3%, 28.8% and 42.9%, respectively.

Conclusions

PM is a rare but fatal infection. Due to chest adhesion and vascular invasion, the proportion of massive bleeding and long operation time has increased sharply.

Breaking the mold: A case of pulmonary mucormycosis treated with isavuconazole

Pulmonary mucormycosis is a rare opportunistic invasive fungal infection that disproportionately affects immunocompromised hosts and carries high morbidity and mortality. It is traditionally treated with combined pharmacologic and surgical modalities. Here we present a case of pulmonary mucormycosis in a patient whose disease burden precluded surgical management, and in whom acute kidney injury necessitated therapy with an alternative to the recommended pharmacologic antifungal therapy.