Pulmonary mucormycosis in a chronic hemodialysis patient : An autopsy case report

Abstract

A 55-year-old male with diabetic nephropathy received hemodialysis treatment 3 times a week over a 9-year period. In February 2008, he was hospitalized with acute respiratory failure. Steroid pulse therapy was performed under a diagnosis of interstitial pneumonia with acute progression. However, he developed respiratory failure and consequently required mechanical ventilation. There was no improvement in the interstitial pneumonia and persistent infection was observed despite intensive care. Rhizopus sp. belonging to the order Mucorales was microbiologically detected in the sputum aspirated during bronchoscopy. Therefore, liposomal amphotericin B (L-AMB) was administered for pulmonary mucormycosis (zygomycosis). However, the patient died due to respiratory failure approximately 3 weeks after the admission. Microscopic examination of autopsy samples confirmed that numerous fungal thrombi had occluded the pulmonary vessels. Generally, it is difficult to diagnose and treat mucormycosis due to the low detection rate of the fungus and the rapidly progressive nature of the condition. Physicians should consider mucormycosis as a differential diagnosis in patients with end-stage renal disease associated with conditions such as antibiotic-refractory infection, negative β-D-glucan, and invasive fungal infection.