Pulmonary mucormycosis and aspergillosis co-infection in an immunocompetent host: a rare case report with review of literature.

Pulmonary aspergillosis and mucormycosis are rare opportunistic infections that usually occur in immunocompromised patients and in patients with multiple comorbidities. Mucormycosis is even rarer in immunocompetent patients. In this case report, we present a case of co-infection of mucormycosis and aspergillosis in a young female with no comorbidities and no immunosuppression. A 27-year-old female patient presents with a history of hemoptysis and intermittent fever for a year with associated history of weight loss. She also has a history of tuberculosis for which she completed treatment. There is no history of any known comorbidity or immunosuppression. High-resolution computed tomography (HRCT) was suggestive of air crescent sign involving the right upper lobe. The patient underwent right upper lobectomy through a right posterolateral approach. Histopathology was suggestive of a fungal ball (mucormycosis and aspergillosis). The patient was administered liposomal amphotericin B intravenously for 14 days and oral posaconazole 300 mg for 3 months. Postoperative follow-up period of 3 and 6 months was uneventful. Mucormycosis and aspergillosis are rare co-infections that could potentially lead to death. These infections usually occur in the immunocompromised population but a high index of suspicion is needed also in immunocompetent patients. Early detection by a multidisciplinary approach, appropriate antifungal therapy, and, if necessary, surgical resection are essential in the treatment of this co-infection. There is no clear consensus on the treatment of mixed co-infections that respond differently to standard treatment protocols; hence, antimicrobial therapy must be rationalized.