Abstract
Case. A 55-year-old woman undergoing treatment for chronic kidney disease was hospitalized in September 2008 because of worsening productive cough and fever. Chest computed tomography revealed patchy pulmonary shadows and cavitary consolidations. A definitive diagnosis of pulmonary mucormycosis was made on the basis of bronchoscopic transbronchial lung biopsy. Biopsy specimens showed broad non-septate hyphae with right-angled branching, a specific finding of mucormycosis. Liposomal amphotericin B was administered until late November 2008, which ameliorated her symptoms and reduced the pulmonary shadows. However, there was relapse of pulmonary mucormycosis in early January 2009, accompanied by low-grade fever, fatigue and new pulmonary infiltrates. Despite restarting liposomal amphotericin B, her chest X-ray findings progressively worsened. We assumed that metabolic acidosis and decreased cellular immunity due to chronic kidney disease were associated with resistance to antifungal treatment. Early hemodialysis was initiated, although her serum creatine level was 4.8mg/dl. Subsequently, her symptoms and pulmonary infiltrates resolved completely. Conclusion. We considered that early hemodialysis contributed to the inhibition of fungal proliferation by improving her cellular immunity and metabolic acidosis.
