Multimodal non-surgical management of isolated tracheobronchial mucormycosis: a case series of 8 patients.

BACKGROUND

Isolated tracheobronchial mucormycosis (ITBM), a distinct subtype of pulmonary mucormycosis (PM), is a relatively rare but life-threatening infection. Here, we present our experience in the multimodal comprehensive treatment of ITBM.

METHODS

We conducted a retrospective descriptive case series of ITBM patients at the Affiliated Hospital of Yunnan University from 2020 to 2023. Demographic characteristics, underlying diseases, clinical manifestations and details of treatment were collected.

RESULTS

A total of 8 patients (3 males, 37.5%) with a mean age of 50.8 years were included. Diabetes was the most common risk factor and ITBM tended to involve the left main bronchus. All 8 patients started with intravenous antifungal therapy and transitioned to oral therapy once stable. Five (62.5%) received posaconazole injection, and six (75%) received posaconazole tablets. The average durations were 5.5 weeks for intravenous antifungal therapy, 17.4 weeks for oral therapy, and 22.9 weeks for total systemic therapy. Regarding topical antifungal therapy, a total of 7 (87.5%) patients were administered atomized inhalation of amphotericin B deoxycholate (AmBD) (2.5-5 mg/dose, twice daily), and the mean treatment time was 27.3 days. Similarly, seven (87.5%) patients received bronchoscopic instillation of AmBD (2.5-20 mg/dose, twice a week), with an average number of 5.6. All patients underwent bronchoscopic interventional treatment. The most frequently used interventional treatments were argon plasma coagulation (APC), cryoresection, and balloon dilatation. To maintain airway patency, 3 patients underwent tracheal silicone stent implantation. The main complication of interventional therapy was mild hemoptysis (50%). Finally, all patients achieved complete remission, with a mean time from diagnosis to complete remission of 5.3 months.

CONCLUSION

In this case series of ITBM, a non-surgical multimodal management strategy was applied, and favorable clinical outcomes were observed during follow-up.

CLINICAL TRIAL NUMBER: Not applicable.