Pulmonary Mucormycosis in a Patient With Uncontrolled Diabetes

Dr. Lipatov, Dr. Patel, Dr. Lat, and Dr. Shakespeare are Internal Medicine Residents at Scott and White Memorial Hospital. Dr. Wang and Dr. Prakash are Physicians at the Central Texas Veterans Health Care System; all in Temple, Texas. Correspondence: Dr. Lipatov (Kirill.Lipatov @BSWHealth.org) Mucorales fungi are ubiquitous organisms commonly inhabiting soil and can cause opportunistic infections. The majority of infections are caused by 3 genera: Rhizopus, Mucor, and Rhizomucor. Infection occurs by inhalation or by direct contact with damaged skin. Mucorales infections can have cutaneous, rhinocerebral, pulmonary, gastrointestinal, and central nervous system manifestations. Pulmonary mucormycosis is often rapidly progressive with angioinvasion and fulminant necrosis causing acute dyspnea, hemoptysis, and chest pain. More indolent pulmonary Mucorales infections can mimic a pulmonary mass with occasional cavitation found on imaging studies similar to other fungal infections (eg, Aspergillus). Risk factors include severe uncontrolled diabetes mellitus (DM), recurrent diabetic ketoacidosis (DKA), immunosuppression due to congenital or acquired causes, hematologic malignancies, and chronic renal failure. The authors present a case of a patient with recurrent DKA and pulmonary mucormycosis.