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Weekly Chest CasesArchive of Old Cases

Case No : 1103 Date 2018-12-17

  • Courtesy of Kyungsun Nam, Yoo Jin Hong, Hye-Jeong Lee / Severance Hospital
  • Age/Sex 61 / M
  • Chief ComplaintCough, sputum, dyspnea, known DM patient
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4

Aug 26th

Diagnosis With Brief Discussion

Diagnosis
Pulmonary mucormycosis
Radiologic Findings
Plain radiograph showed multiple cavitary lesions on the both lung fields. Lung window setting CT image showed multiple GGO lesions with surrounding consolidation (reverse halo sign). Increase in size and cavitary change of previous lesions with bilateral pleural effusion were noted on follow up image. Last image revealed improvement of multiple lung lesions after long-term administration of antifungal agent. On sputum culture, Rhizopus microspores (fungus) was detected.
Brief Review
Mucormycosis is an opportunistic infection caused by fungi of the class Zygomycetes, caused by fungal species in the genera Rhizopus, Lichtheimia, and Mucor. Risk factors for infection include diabetes (especially in the setting of diabetic ketoacidosis), hematologic malignancy, stem cell or solid organ transplantation, immunosuppression, graft-versus-host disease, and desferoxamine therapy.
Imaging findings are mostly nonspecific and include consolidation, nodules, masses, cavities, lymphadenopathy, and pleural effusion. Findings suggestive of invasive fungal infection include the air crescent sign (a thin rim of air between the necrotic lung and the surrounding parenchyma) and the halo sign (consolidation with a rim of surrounding GGO). Relatively large size of halo indicates that mucormycosis results in greater pulmonary hemorrhage than other angioinvasive infections, such as Aspergillus infections, that typically have only a small halo around the nodules. The lesions had a peripheral predominance and some patients showed vascular cutoff sign.
Treatment for mucormycosis depends on antifungal agents, surgery, and control of predisposing conditions. Amphotericin B and, more recently, posaconazole are efficacious in the treatment of mucormycosis. Voriconazole is not effective, although it is effective in the treatment of aspergillosis.
References
1. Hammer MM, Madan R, Hatabu H. Pulmonary Mucormycosis: Radiologic Features at Presentation and Over Time. AJR Am J Roentgenol. 2018;210:742-747
2. Chung JH, Godwin JD, Chien JW, Pipavath SJ. Pulmonary mucormycosis. Radiology. 2010;256:667-70
Keywords
Lung, Fungal infection,

No. of Applicants : 73

▶ Correct Answer : 36/73,  49.3%
  • - The University of Kyoto Hospital , Japan TOMOAKI OTANI
  • - Saitama-Sekishinkai Hosptal , Japan MIHOKO YAMAZAKI
  • - ZIGONG TCM HOSPITAL OF CHINA , China Cao Cunyou
  • - Kinki University Faculty of Medicine, , Japan MITSURU MATSUKI
  • - Showa University Fujigaoka Hospital , Japan KYOKO NAGAI
  • - Niigata University , Japan ATSUSHI UEHARA
  • - Higashi-Ohmi General Medical Center , Japan AKITOSHI INOUE
  • - The University of Tokyo Hospital , Japan Akifumi Hagiwara
  • - , United Kingdom SAMSON K
  • - NIMS, HYDERABAD , India BHASKAR K
  • - Vita Hospital , Brazil DIOGO LAGO PINHEIRO
  • - Other , Korea (South) SEONGSU KANG
  • - DELTA CARE HOSPITAL, THANJAVUR, INDIA , India SIVARAJA SUBRAMANIAM
  • - Freelance resident in Reunion Island , Reunion Fabien HO
  • - Oita University, Faculty of Medicine , Japan Fumito Okada
  • - The Jikei university , Japan TAKU GOMI
  • - The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
  • - Narayana Multispeciality Hospital Jaipur Rajasthan , India JAINENDRA JAIN
  • - Gifu University Hospital , Japan Yo Kaneko
  • - Dong-A University, College of Medicine , Korea (South) KI-NAM LEE
  • - The University of Tokyo Hospital , Japan RYO KUROKAWA
  • - Ewha Womans University Medical Center , Korea (South) YOUNGSUN KO
  • - National Taiwan University Hospital Hsin-Chu Branch , Taiwan LI-TA KENG
  • - CLINIQUE STE CLOTILDE , Reunion PATRICK MASCAREL
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey MERIC TUZUN
  • - , Japan NAOMI YUASA
  • - Azienda Ospedaliera di Cremona , Italy Pietro Sergio
  • - Chonbuk National University Hospital , Korea (South) KUM JU CHAE
  • - TB centre kasaragod. , India rikhy krishnan
  • - Teikyo University Hospital , Japan KAORU SUMIDA
  • - , Korea (South) JONGSUN LEE
  • - College of Medicine, CHA University , Korea (South) PARK JONG WON
  • - Hamamatsu University Hospital , Japan YUKI HAYASHI
  • - Chonnam National University Hwasun Hospital , Korea (South) JONG EUN LEE
  • - Ajou University Hospital , Korea (South) YONG HO JANG
  • - Seoul Veterans Hospital , Korea (South) HYUN JUNG YOON
▶ Correct Answer as Differential Diagnosis : 6/73,  8.2%
  • - Chonbuk National University Hospital , Korea (South) MINGI SHIN
  • - McGill University Health Center , Canada Alexandre Semionov
  • - Onomichi municipal hospital , Japan Hirofumi Mifune
  • - Wuhan Union Hospital , China NANCHUAN JIANG
  • - Samsung Medical Center , Korea (South) MIN YEONG KIM
  • - the first affiliatited hospital of nanjing medical univercity , China HAI XU
▶ Semi-Correct Answer : 3/73,  4.1%
  • - Kyoto Prefectural University of Medicine , Japan TADASHI TANAKA
  • - National Center for Global Health and Medicine , Japan HIROSHI TAKUMIDA
  • - Diagnose.me (BV) / Royal Perth Hospital , Australia YURANGA WEERAKKODY
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