A 74-Year-Old Man With Easy Bruising and Fatigue

Arunabh Talwar, MD; Craig E. Devoe, MD; Nick Patel, DO


February 09, 2017

Treatment generally starts with control of the patient's underlying disease, which is often difficult to accomplish. Withdrawal of immunosuppressive agents and corticosteroid drugs, glycemic control, and correction of acidosis are all advisable. Amphotericin B remains the only antimicrobial agent with evidence of antifungal efficacy in mucormycosis. Sensitivity to amphotericin varies between isolates. Host factors, such as infarcted tissue, and poor host immunocompetence will affect the success of treatment. Early and aggressive surgery for localized disease appears to offer the best chance of recovery, especially in diabetics with hemoptysis.[3,5]

Presentation with endobronchial disease is distinctly rare. Even less common is presentation with endobronchial disease confined to a well-localized area. Again, treatment of endobronchial mucormycosis is primarily surgical. The high degree of vascular invasion and resultant infarction make it unlikely that amphotericin will be effectively delivered to the involved areas.[9] Recognizing that the presentation of pulmonary mucormycosis depends on the associated clinical disorder is important.

Patients with leukemia and lymphoma often have diffuse parenchymal disease refractory to medical and surgical therapy. Some patients have localized disease amenable to surgery with or without amphotericin. Overall, early consideration of pulmonary mucormycosis should lead to earlier diagnosis, appropriate medical and surgical therapy, and an increased survival rate.[3]

The patient in this case was treated with intravenous amphotericin B for 4 weeks along with endobronchial resection of the lesions. Radiographically and clinically he completely improved after this treatment. This is a rather interesting exception to the normal treatment for endobronchial disease, as he was not primarily managed with surgery. His antifungal regimen did not appear to affect his leukemia treatment, as his induction chemotherapy with cytarabine and daunorubicin showed chemotherapeutic effect at day 21 post-induction, which was demonstrated with a bone marrow biopsy. The patient recovered bone marrow function in a timely fashion.


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