Pulmonary mucormycosis masquerading as malignancy in a Non-Diabetic Patient

A 75-year-old male with chronic obstructive pulmonary disease (COPD) (on inhaled fluticasone/umeclidinium/vilanterol and intermittent intravenous methylprednisolone) presented with a 4-week history of intermittently productive cough and mucoid sputum. He denied fever, weight loss or haemoptysis. The patient had a 40-pack-year smoking history but no diabetes, haematological malignancies or tuberculosis. Physical examination revealed bilaterally reduced breath sounds. Laboratory tests showed mild anaemia (haemoglobin 114 g/L) and elevated C-reactive protein (21.4 mg/L). Serum galactomannan and cryptococcal antigen tests were negative. Chest CT revealed a 15×11 mm solid nodule in the left lower lobe with short spiculation and lobulation (figure 1A). Given the suspicion of malignancy, a CT-guided percutaneous biopsy was performed. Periodic acid-Schiff (PAS) staining (figure 2A) revealed broad, non-septate hyphae (predominantly ranging from 5 to 20 µm in diameter) with right-angle branching. Polysaccharide immunofluorescence (figure 2B) highlighted fungal hyphae with intense fluorescence signals, revealing broad, non-septate hyphae with right-angle branching patterns. These histopathological findings are consistent with mucormycosis. Figure 1 (A) Axial chest CT on admission demonstrates a solid nodule with short spiculation and lobulation in the left lower lobe (arrow). (B) Follow-up chest CT after 5 months of therapy reveals a significant reduction in the …