Severe angioinvasive pulmonary mucormycosis in an immunocompetent patient with poorly controlled diabetes: a case report.

Abstract

Background: Pulmonary mucormycosis is a rare, life-threatening angioinvasive fungal infection that predominantly affects immunocompromised hosts but can also occur in patients with poorly controlled diabetes mellitus. Its nonspecific presentation may delay diagnosis and treatment.

Case presentation: We report the case of a 63-year-old Syrian male with a 25-year history of poorly controlled type 2 diabetes mellitus and heavy smoking, who presented with pleuritic chest pain, productive brownish sputum, fatigue, anorexia, and progressive dyspnea. Empirical antibacterial therapy for presumed community-acquired pneumonia failed to achieve clinical or radiological resolution. Chest computed tomography revealed a left upper-lobe cavitary lesion with surrounding consolidation and necrotic changes. CT-guided transthoracic biopsy showed broad, ribbon-like, nonseptate hyphae with right-angle branching, confirming pulmonary mucormycosis. Because fungal culture did not yield a viable isolate, susceptibility testing could not be performed. The patient received intravenous liposomal amphotericin B for 40 days, followed by left upper lobectomy with lingulectomy. His postoperative course was uneventful, with marked symptomatic improvement.

Discussion: This case emphasizes the need to consider pulmonary mucormycosis in diabetic patients with atypical, cavitary, or nonresolving pneumonia despite antibacterial therapy. Imaging may support clinical suspicion, but histopathological confirmation remains essential.

Conclusion: Early suspicion, prompt tissue diagnosis, liposomal amphotericin B therapy, metabolic risk-factor control, and surgical resection when disease is localized may be life-saving.