Diagnostic microbiology and infectious disease · 2026
Successful treatment of pulmonary mucormycosis caused by Rhizopus arrhizus in a diabetic patient with combined bronchoscopic local and systemic antifungal therapy: A case report and literature review.
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Kou Dongling, He Liqun, Jin Yang, Li Jun, Wang Jiankun, Wang Yue
Аннотация
OBJECTIVE: To present the clinical course and therapeutic outcome of a diabetic patient with bilateral pulmonary mucormycosis (PM) caused by Rhizopus arrhizus, successfully managed by a combined systemic and bronchoscopic local antifungal therapy.
METHODS: A 52-year-old male with poorly controlled type 2 diabetes presented with persistent fever, cough, and chest pain. Chest CT revealed bilateral lower lobe consolidations with cavitation. Bronchoscopy showed endobronchial obstruction by necrotic material. Diagnosis was established via rapid on-site evaluation (ROSE), histopathology, and targeted next-generation sequencing (tNGS) of bronchoalveolar lavage fluid, which identified Rhizopus arrhizus.
RESULTS: Following an unsatisfactory response to initial intravenous amphotericin B monotherapy, a triple-modality regimen was initiated: continuous intravenous infusion of liposomal amphotericin B, oral isavuconazole, and bi-weekly bronchoscopic instillation of amphotericin B cholesteryl sulfate complex directly into the affected segment. This combined approach led to rapid symptom resolution, radiographic improvement, and patent bronchi on follow-up bronchoscopy. The patient remained well during long-term follow-up.
CONCLUSION: This case demonstrates the potential efficacy of an integrated strategy combining early tNGS-guided diagnosis, stringent glycemic control, and a synergistic systemic-local antifungal regimen for bilateral PM in a non-surgical candidate. While the relative contribution of each intervention cannot be determined from a single report, the successful outcome suggests that this triple-modality approach may be a viable option for selected patients with diffuse, non-surgical PM. It underscores the potential of bronchoscopic local therapy to enhance drug delivery and warrants further investigation through larger case series or registries.
METHODS: A 52-year-old male with poorly controlled type 2 diabetes presented with persistent fever, cough, and chest pain. Chest CT revealed bilateral lower lobe consolidations with cavitation. Bronchoscopy showed endobronchial obstruction by necrotic material. Diagnosis was established via rapid on-site evaluation (ROSE), histopathology, and targeted next-generation sequencing (tNGS) of bronchoalveolar lavage fluid, which identified Rhizopus arrhizus.
RESULTS: Following an unsatisfactory response to initial intravenous amphotericin B monotherapy, a triple-modality regimen was initiated: continuous intravenous infusion of liposomal amphotericin B, oral isavuconazole, and bi-weekly bronchoscopic instillation of amphotericin B cholesteryl sulfate complex directly into the affected segment. This combined approach led to rapid symptom resolution, radiographic improvement, and patent bronchi on follow-up bronchoscopy. The patient remained well during long-term follow-up.
CONCLUSION: This case demonstrates the potential efficacy of an integrated strategy combining early tNGS-guided diagnosis, stringent glycemic control, and a synergistic systemic-local antifungal regimen for bilateral PM in a non-surgical candidate. While the relative contribution of each intervention cannot be determined from a single report, the successful outcome suggests that this triple-modality approach may be a viable option for selected patients with diffuse, non-surgical PM. It underscores the potential of bronchoscopic local therapy to enhance drug delivery and warrants further investigation through larger case series or registries.