Endobronchial Hemorrhage in Bronchopulmonary Mucormycosis
Endobronchial Hemorrhage in Bronchopulmonary Mucormycosis
Introduction: During infection, Mucorales fungi invade major blood vessels, leading to extensive necrosis, and in cases of extensive pulmonary disease, bleeding into the lungs may occur.
Case presentation: We report an unexpected event of post-bronchoscopy fatal endobronchial hemorrhage in a 62-year-old HIV-negative Italian woman with well controlled diabetes mellitus who presented with diffuse cavitated pulmonary lesions. Fiberoptic bronchoscopy revealed bilateral obstruction of the segmental bronchi. Fatal massive bleeding occurred after standard biopsy procedures. Histologic examination showed that the hyphae were more deeply colored by hematoxylin-eosin (H&E) than by other stains for fungi. Culture and autopsy confirmed bronchopulmonary mucormycosis.
Conclusion: Infection by Mucorales fungi should be considered in the diabetes population regardless of the degree of metabolic control. In these patients, particular caution should be taken during bronchoscopic procedures because of the greater friability of the fungal lesions.
"Zygomycosis" refers to infections caused by a class of fungi called Zygomycetes, which includes the genera Rhizopus, Absidia, and Rhizomucor. They had previously been assigned to the genus Mucor and were considered responsible for the disease known as "mucormycosis". These fungi are ubiquitous in nature and are common inhabitants of decomposing matter. They can cause serious and rapidly fatal infections, particularly in individuals with compromised immune systems, such as those with poorly controlled diabetes with ketoacidosis.
The fungi invade major blood vessels, leading to extensive necrosis, and in extensive pulmonary disease, bleeding into the lungs may occur. In patients with diabetes mellitus, pulmonary mucormycosis may develop, with a less fulminant disease course but with atypical presentation of a solitary nodule.
Biopsy (surgical or transbronchial) of abnormal tissue retrieved by bronchoscopic aspiration or bronchoalveolar lavage (BAL) via a bronchoscope and microbiologic evaluation are the most efficient methods for detecting endobronchial Mucor. We report a rare case of diffuse pulmonary mucormycosis in a patient with well-controlled type 2 diabetes who had a fatal pulmonary hemorrhage during a fiberoptic bronchoscopy procedure.
Abstract and Introduction
Abstract
Introduction: During infection, Mucorales fungi invade major blood vessels, leading to extensive necrosis, and in cases of extensive pulmonary disease, bleeding into the lungs may occur.
Case presentation: We report an unexpected event of post-bronchoscopy fatal endobronchial hemorrhage in a 62-year-old HIV-negative Italian woman with well controlled diabetes mellitus who presented with diffuse cavitated pulmonary lesions. Fiberoptic bronchoscopy revealed bilateral obstruction of the segmental bronchi. Fatal massive bleeding occurred after standard biopsy procedures. Histologic examination showed that the hyphae were more deeply colored by hematoxylin-eosin (H&E) than by other stains for fungi. Culture and autopsy confirmed bronchopulmonary mucormycosis.
Conclusion: Infection by Mucorales fungi should be considered in the diabetes population regardless of the degree of metabolic control. In these patients, particular caution should be taken during bronchoscopic procedures because of the greater friability of the fungal lesions.
Introduction
"Zygomycosis" refers to infections caused by a class of fungi called Zygomycetes, which includes the genera Rhizopus, Absidia, and Rhizomucor. They had previously been assigned to the genus Mucor and were considered responsible for the disease known as "mucormycosis". These fungi are ubiquitous in nature and are common inhabitants of decomposing matter. They can cause serious and rapidly fatal infections, particularly in individuals with compromised immune systems, such as those with poorly controlled diabetes with ketoacidosis.
The fungi invade major blood vessels, leading to extensive necrosis, and in extensive pulmonary disease, bleeding into the lungs may occur. In patients with diabetes mellitus, pulmonary mucormycosis may develop, with a less fulminant disease course but with atypical presentation of a solitary nodule.
Biopsy (surgical or transbronchial) of abnormal tissue retrieved by bronchoscopic aspiration or bronchoalveolar lavage (BAL) via a bronchoscope and microbiologic evaluation are the most efficient methods for detecting endobronchial Mucor. We report a rare case of diffuse pulmonary mucormycosis in a patient with well-controlled type 2 diabetes who had a fatal pulmonary hemorrhage during a fiberoptic bronchoscopy procedure.
