Successful treatment of mixed pulmonary Aspergillus and Mucor infection using intrabronchial amphotericin B infusion: a case report and literature review

• Published in: BMC pulmonary medicine 2024-09, Vol.24 (1), p.436-6, Article 436
• Main Authors: Ling, Fei-Xiang, Qu, Dong-Ming, Lu, Ye-Quan, Li, Rou, Zhao, Lei
• Format: Article
• Language: English
• Subjects: Amphotericin B; Amphotericin B - administration & dosage; Amphotericin B - therapeutic use; Antifungal agents; Antifungal Agents - administration & dosage; Antifungal Agents - therapeutic use; Antiparasitic agents; Aspergillosis; Aspergillus; Biopsy; Blood vessels; Bronchoscopic treatment; Bronchoscopy; Care and treatment; Case Report; Case reports; Coinfection - drug therapy; Complications and side effects; Coronaviruses; COVID-19; Development and progression; Diabetes; Diabetes mellitus; Diagnosis; Disease; Dosage and administration; Drug therapy; Drugs; Fatalities; Fungal infections; Health aspects; Hospitals; Humans; Immunosuppressive agents; Infection; Invasive fungal infections; Literature reviews; Lung diseases; Lung diseases, Fungal; Lungs; Male; Medical prognosis; Middle Aged; Mortality; Mucor; Mucor - isolation & purification; Mucormycosis; Mucormycosis - diagnosis; Mucormycosis - drug therapy; Pathogens; Patient outcomes; Patients; Pneumonia; Posaconazole; Pulmonary aspergillosis; Pulmonary Aspergillosis - diagnosis; Pulmonary Aspergillosis - drug therapy; Pulmonary mucormycosis; Sulbactam; Surgery; Tomography, X-Ray Computed; Tuberculosis
• ISSN: 1471-2466; 1471-2466
• DOI: 10.1186/s12890-024-03234-z

Reports of pulmonary aspergillosis and mucormycosis co-infections are rare; thus, limited guidance is available on early diagnosis and treatment. We present a case of mixed pulmonary Aspergillus and Mucor infection and review the literature regarding this co-infection. The diagnosis and treatment methods are summarized to improve clinicians' understanding of the disease and to facilitate early diagnosis and treatment. A 60-year-old male farmer with poorly controlled diabetes mellitus was admitted to hospital with a fever of unknown origin that had been present for 15 days and pulmonary aspergillosis complicated by Mucor spp. Because multiple lobes were involved, the infection worsened despite surgical resection and antifungal therapy. Finally, we treated this patient with a bronchoscopic infusion of amphotericin B. After four courses of bronchoscopic amphotericin B infusion, we observed rapid clinical improvement and subsequent resolution of pulmonary infiltrates. Our case highlights the use of bronchoscopy in the successful clinical treatment of invasive fungal diseases of the lung.