A Case of Isolated Pulmonary Mucormycosis in an Immunocompetent Host
A 52-year-old male presented to our hospital with a chief complaint of sputum. Productive cough with yellowish sputum for two months, four pulmonary nodule in both lungs which was detected in chest computed tomography (CT).\nUsing inhalers (tiopropium, salmeterol/fluticasone) because of chronic obstructive pulmonary disease (COPD) which was diagnosed 15 years ago. Seven years ago, he received occasionally a intravenous steroids because of COPD flare-ups which occurs one or two time. Pulmonary tuberculosis had been treated for three-years medical care in 13 years ago. Hepatitis C was diagnosed in 10 years ago.\nHis vital signs were within the normal range. There was no lymphadenopathy in the cervical, axillary, or inguinal regions. His had barrel chest. On auscultation of the chest, a coarse breathing sound with wheezing in left upper lung fields was heard.\nLaboratory data were within the normal range. Blood glucose was 116 mg/dL. HbA1c was 6.1%. Hepatitis C virus antibody test was positive. Human immunodeficiency virus antigen and antibody were negative, Paragonimus antibody and Aspergillus antigen were negative.\nA chest radiography showed an inactive tuberculosis scar in right upper lobe and two nodules in left lower lobe (). A CT scan of the chest showed three nodules in left lower lobe, a nodule in right lower lobe, and emphysema ().\nWe confirmed no endobronchial lesion by bronchoscopy. The bronchoscopic washing specimen was negative for the acid-fast bacilli smear and culture test, and also for the microbial and fungal culture test. A transcutaneous needle biopsy of the nodule at left lower lobe showed thick fungal hyphe with right-angle branching, highly suggestive for mucormycosis (). Because the patient was immunocompetent, we screened other affected lesion. However brain magnetic resonance imaging and nasal endoscopy showed no apparent lesion.\nThe patient was started on amphotericin B. Surgical resection of the affected lobe was not possible treatment option, because pulmonary function test showed that forced expiratory volume in one second of the patient was 45%. Amphotericin B was used during 1 week and discontinued after discharge. Posaconazole oral suspension was started for home treatment. Total treatment duration is 3 months. After treatment, the chest CT in the follow-up showed that the size of the nodules was reduced (). After the end of the treatment for 3 months, chest radiography revealed no definitive relapse of mucormycosis ().