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Weekly Chest CasesArchive of Old Cases

Case No : 559 Date 2008-07-14

  • Courtesy of Gong Yong Jin, MD. / Chonbuk National University Medical, Korea.
  • Age/Sex 59 / F
  • Chief ComplaintChronic cough / PHx: 1. Hypertension, 2. DM nephropathy, 3.Treatment for pneumonia at local clinics before admission.
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4

Diagnosis With Brief Discussion

Diagnosis
Mucomycosis
Radiologic Findings
On admission, there was lobar consolidation in RLLF at chest PA. Contrast-enhanced CT showed obstructive pneumonia due to endobronchial obstruction in the right lower lobar bronchus. Endobronchial mass showed homogenous low density with complete obstruction from right lower lobar bronchus to proximal segmental bronchus of right lower lobe at contrast-enhanced CT. Two days later, new bilateral increased opacity on BULF occurred at chest PA due to DM nephropathy. Endobronchial mass showed hypermetabolism at PET/CT. The pathology revealed thickened, non-segmental hyphae with right angle branching pattern. Endobronchial mass confirmed Mucomycosis on pathologic findings.
Brief Review
Opportunistic fungal infection is a common cause of serious morbidity and mortality in immunocompromised patients such as DM, chemotherapy-induced neutropenia, acquired immunodeficiency syndrome or immunosuppression after solid organ or bone marrow transplantation. The most important opportunistic fungal pathogens include Aspergillus species, Cryptococcus neoformans, Candida, and Mucormycosis. In diabetic patients, ketoacidosis seems to be a significant predisposing factor, because the functional integrity of neutrophils and Bronchoalveolar macrophages is impaired. The common radiologic finding of pulmonary mucormycosis is lobar or multilobar consolidation. Less commonly, one or multiple nodules or masses with/without cavity can be seen. The most common CT finding is focal or diffuse extension of low attenuation within consolidation and the halo sign. Definite diagnosis usually requires histologic demonstration of the organism in affected tissue. Overall mortality rate of pulmonary mucormycosis is 45%.
References
1. Connolly JE, McAdams HP, Erasmus JJ, Rosado-de-Christenson ML. Opportunistic fungal pneumonia. J Thorac Imaging 1999;14:51-62
2. Chinn R, Diamind R. Generation of chemotactic factors by Rhyzopus oryzae in th presence and abscence of serum; relationship to hypal damage mediated by human neutrophils and effects of hyperglycemia and ketoacidosis. Infect Immun 1982;38:1123-1129
3. McAdams HP, Christenson MR, Strollo DC, Edward FP. Pulmonary mucormycosis: radiologic findings in 32 cases. AJR 1997;168:1541-1548.
Keywords
Airway, Lung, Infection, Fungal infection, Immunocompromised,

No. of Applicants : 74

▶ Correct Answer : 9/74,  12.2%
  • - China Medical University,Taiwan,R.O.C. , Taiwan Jun Jun Yeh
  • - Soon chun hyang university hospital bucheon , Korea (South) Hyelin Kim
  • - radiology department ANNECY , France gilles GENIN
  • - Gimpo Woori Hospital , Korea (South) Son Youl Lee
  • - Chungnam National University hospital , Korea (South) Kyoung Jin Oh
  • - IRSA La Rochelle France , France Denis Chabassie
  • - Armed Forces Chun-Cheon Hospital , Korea (South) ChaeHun Lim
  • - All India Institute of Medical Sciences , India puneet kochar
  • - Asan Medical Center , Korea (South) Eun Jin Chae
▶ Semi-Correct Answer : 14/74,  18.9%
  • - McGill University Health Centre , Canada Amr Ajlan
  • - OSWAL CANCER HOSPITAL , India LOVKESH MITTAL
  • - Vitalife Clinics , Pune , India. , India Rahul Deshmukh
  • - Marien Hospital, Hamm , Germany Davis Chiramel
  • - Deptt of Radiodiagnosis & Imaging, PGIMER chandigarh , India Ram Galwa
  • - E-DA Hospital / I-Shou University , Taiwan Yu-Feng Wei
  • - National Taiwan University Hospital , Taiwan Nin Chieh Hsu
  • - Dongguk University International Hospital , Korea (South) Hee Seok Choi
  • - Homs National Hospital , Syria Rami Abou Zalaf
  • - Depatment of Radiology, Yongsan Hospital, College of Medicine, Chung-Ang University , Korea (South) Jae Seung Seo
  • - IRSA LA ROCHELLE FRANCE , France jean-luc BIGOT
  • - Vital Imaging Centre, Mumbai,India , India Ganesh Agrawal
  • - Medical College Chest Hospital,Thrissur,Kerala , India Raveendran TK
  • - All India Institute of Medical Sciences , India Ashish Gupta
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