ReviewThe American journal of case reports2025
Successful Management of Refractory Pulmonary Mucormycosis Using Intracavitary Amphotericin B: A Case Report and Literature Review.
Review in The American journal of case reports, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
BACKGROUND Mucormycosis is a rapidly invasive, highly fatal infection typically affecting immunocompromised patients, such as those with diabetes, hematologic malignancies, or HIV. We report a case of pulmonary mucormycosis in a female patient in which initial systemic therapy failed. CT-guided intracavitary amphotericin B instillation was used as salvage therapy. This approach delivered high-dose antifungal medication directly to the infection site, leading to significant clinical and radiological improvement. CASE REPORT We report a case of pulmonary mucormycosis complicated with Klebsiella pneumoniae infection in a 51-year-old female patient who had a history of diabetes. This patient was admitted to the hospital for dyspnea, chest pain, and fever, and a chest CT on admission suggested multiple inflammatory lesions in both lungs (involving abscesses or fungi). Bronchoscopy revealed left upper-lobe suppurative inflammation. Initial bronchoalveolar lavage fluid (BALF) tests (smears, culture, GM, X-pert) were negative. Finally, the BALF was tested by targeted next-generation sequencing (tNGS), and the diagnosis of pulmonary mucormycosis co-infected with Klebsiella pneumoniae was confirmed. After 21 days of treatment with intravenous amphotericin B and posaconazole, lung nodules/cavities (Mucor) showed no improvement, suggesting inadequate local drug penetration. The patient was ultimately treated with combined local (CT-guided intrapulmonary amphotericin B injection and nebulization) and systemic (intravenous amphotericin B and posaconazole) antifungal therapy, resulting in partial resolution of pulmonary cavities on follow-up CT. CONCLUSIONS This case report presents an innovative management strategy for mucormycosis; combined local and systemic antifungal therapy achieved clinical improvement despite limited intracavitary injections, providing a potential therapeutic approach for this challenging infection.
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