Chest Infections: Fellow Case Report Slide: Chest Infections II |

Endobronchial Zygomycosis: A Rare Presentation of a Fatal Infection FREE TO VIEW

Madhu Kalyan Pendurthi, MBBS; Christina Kao, MD; Pralay Sarkar, MD; Kalpalatha Guntupalli, MD
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Baylor College of Medicine, Houston, TX

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):136A. doi:10.1016/j.chest.2016.08.145
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SESSION TITLE: Fellow Case Report Slide: Chest Infections II

SESSION TYPE: Affiliate Case Report Slide

PRESENTED ON: Tuesday, October 25, 2016 at 07:30 AM - 08:30 AM

INTRODUCTION: Pulmonary Zygomycosis is a serious, life threatening infection in immunocompromised patients with stem cell or solid organ transplantation, in patients with hematological malignancy and prolonged neutropenia. We describe a case which presented with an endobronchial mass lesion and was treated with a combination of bronchoscopic intervention and systemic antifungal therapy.

CASE PRESENTATION: A 27 year man presented to emergency room with fever and dry cough. He has known pre-B cell acute lymphoblastic leukemia and underwent chemotherapy for a relapse about 2 months ago. Patient had severe and prolonged neutropenia. Prior to hospitalization, he was treated for a pneumonia with broad spectrum antibiotics. Radiograph of chest showed a left lower lobe infiltrate, while CT scan showed bilateral lower lobe nodules in centrilobular distribution with tree-in-bud appearance, additionally, a dense, mass-like acinar infiltrate was noted in the left lower lobe. Flexible bronchoscopy showed an endobronchial mass occluding the posterior sub segment of left lower lobe bronchus. Broncho-alveolar lavage cytology showed numerous fungi morphologically consistent with Zygomycetes species. Treatment with liposomal amphotericin B was initiated. In view of his immunocompromised state, risks of post obstructive pneumonia and hemoptysis, removal of the mass was planned. Severe, refractory thrombocytopenia precluded surgical resection. Repeat flexible bronchoscopy was performed under general anesthesia after platelet transfusion. Using a cryotherapy probe the endoluminal mass was removed in piecemeal. Histopathology was consistent with Zygomycetes.

DISCUSSION: Pulmonary Zygomycosis causes angioinvasion resulting in cavitation and life threatening hemoptysis. Clinical and radiological presentation is nonspecific and overlaps with aspergillosis. Mortality is as high as 40-76%. Histopathology of tissue biopsy is specific for diagnosis. Improvement in neutropenia, systemic therapy with amphotericin B and debridement of the lesion, when feasible, are critical for success of treatment.

CONCLUSIONS: Early diagnosis and treatment are imperative in improving the survival. In surgically non-resectable cases, bronchoscopic removal of a large component of endobronchial disease may help in recovery.

Reference #1: Pyrgos V, Shoham S, Walsh TJ. Pulmonary zygomycosis. Semin Respir Crit Care Med. 2008;29(2):111-20.

Reference #2: Rojas-tula DG, Gómez-fernández M, García-lópez JJ, et al. Endobronchial cryotherapy for a mycetoma. J Bronchology Interv Pulmonol. 2013;20(4):330-2

DISCLOSURE: The following authors have nothing to disclose: Madhu Kalyan Pendurthi, Christina Kao, Pralay Sarkar, Kalpalatha Guntupalli

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