Dyspnea, Fatigue, and Generalized Weakness in a 67-Year-Old Man:Approach to the Patient Between Guidelines and Clinical Judgment

Mucormycosis are an emerging group of life-threatening fungal infections caused by filamentous fungi of the Mucorales family. Mucormycosis are most common in stem-cell transplant recipients and patients with underlying hematologic malignancies, poorly controlled diabetes mellitus, trauma, neutropenia, corticosteroid and deferoxamine therapy due to deficiency of phagocytic function, elevated serum levels of available iron and host-pathogen interaction. The fungi penetrate blood vessels causing endothelial damage and extensive angioinvasion with infarction, necrosis, and thrombosis of different tissues. Mucormycosis carries a very high mortality in cases of pulmonary disease, with even higher rates when there is difficulty establishing the diagnosis. We present a case of 67-year-old man with pulmonary form of mucormycosis presenting as opportunistic infection post induction chemotherapy for acute myeloid leukemia FAB M2. We treated the patient with intravenous amphotericin B for 4 weeks and endobronchial resection, after which he clinically and radiographically improved. Overall, early consideration of mucormycosis can lead to an earlier diagnosis, medical and surgical therapy, and an increased survival rate. Furthermore, we provide a real example of multiple thinking strategies, needed for a patient oriented clinical practice. Overall, this case is a challenging example between clinical judgment and available validated guidelines.