Isolated tracheobronchial mucormycosis: Report of a case and systematic review of literature

• Published in: Mycoses Vol. 66; no. 1; pp. 5 - 12
• Main Authors: Damaraju, Vikram, Agarwal, Ritesh, Dhooria, Sahajal, Sehgal, Inderpaul Singh, Prasad, Kuruswamy Thurai, Gupta, Kirti, Prabhakar, Nidhi, Aggarwal, Ashutosh N., Muthu, Valliappan
• Format: Journal Article
• Language: English
• Published: Germany Wiley Subscription Services, Inc 01.01.2023
• Subjects: airway aspergillosis; Amphotericin B; Amphotericin B - therapeutic use; Anastomosis; Antifungal Agents - therapeutic use; Bronchoscopy; bronchus; CAM; Case reports; Computed tomography; Coronaviruses; Cough; COVID-19; COVID-19 - complications; Diabetes; Diabetes mellitus; Female; Hemoptysis - drug therapy; Humans; Influenza; Inhalation; Intubation; Literature reviews; Lung transplantation; Male; Middle Aged; mucorales; Mucormycosis; Mucormycosis - diagnosis; Mucormycosis - drug therapy; Patients; Posaconazole; pulmonary mucormycosis; Risk factors; Surgery; Systematic review; pulmonary mucormycosis; airway aspergillosis; bronchus; mucorales; CAM
• ISSN: 0933-7407; 1439-0507; 1439-0507
• DOI: 10.1111/myc.13519

Background Isolated tracheobronchial mucormycosis (ITBM) is an uncommonly reported entity. Herein, we report a case of ITBM following coronavirus disease 2019 (COVID‐19) and perform a systematic review of the literature. Case description and systematic review A 45‐year‐old gentleman with poorly controlled diabetes mellitus presented with cough, streaky haemoptysis, and hoarseness of voice 2 weeks after mild COVID‐19 illness. Computed tomography and flexible bronchoscopy suggested the presence of a tracheal mass, which was spontaneously expectorated. Histopathological examination of the mass confirmed invasive ITBM. The patient had complete clinical and radiological resolution with glycaemic control, posaconazole, and inhaled amphotericin B (8 weeks). Our systematic review of the literature identified 25 additional cases of isolated airway invasive mucormycosis. The median age of the 26 subjects (58.3% men) was 46 years. Diabetes mellitus (79.2%) was the most common risk factor. Uncommon conditions such as anastomosis site mucormycosis (in two lung transplant recipients), post‐viral illness (post‐COVID‐19 [n = 3], and influenza [n = 1]), and post‐intubation mucormycosis (n = 1) were noted in a few. Three patients died before treatment initiation. Systemic antifungals were used in most patients (commonly amphotericin B). Inhalation (5/26; 19.2%) or bronchoscopic instillation (1/26; 3.8%) of amphotericin B and surgery (6/26; 23.1%) were performed in some patients. The case‐fatality rate was 50%, primarily attributed to massive haemoptysis. Conclusion Isolated tracheobronchial mucormycosis is a rare disease. Bronchoscopy helps in early diagnosis. Management with antifungals and control of risk factors is required since surgery may not be feasible.