Respiratory medicine case reports · 2025
Pulmonary mucormycosis complicated with transplant renal dysfunction: A case report.
Клинический случайСтатьяНазвание и аннотация: Перевод в очереди
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Qian Xuejiao, Hong Zheng, Wang Ruxue, Ping Jiang
Аннотация
CASE HISTORY: Patient is a 60-year-old woman admitted with "intermittent dry cough for 3 months". Past medical history includes hypertension, uncontrolled type 2 diabetes mellitus, status post renal transplantation, and chronic renal insufficiency. Initial investigations at an outside hospital revealed leukocytosis (15.8 × 109/L) with neutrophilia (90.9 %). Chest computed tomography (CT) demonstrated multiple high-density masses with cavitation in the right lung and multilobar micronodules.
SYMPTOMS AND SIGNS: Predominantly dry cough, occasionally accompanied by a small amount of white mucous sputum, accompanied by pharyngeal constriction when coughing violently, profuse sweating and loss of appetite; on examination, the right lung respiratory sounds were coarse, and wet rales were detected, and the rest of the lungs were unremarkable.
DIAGNOSTIC METHODS: Bronchoscopy revealed obstruction by necrotic material in the posterior segment of the right upper lobe. Rapid on-site evaluation (ROSE) demonstrated broad, aseptate hyphae with irregular wide-angle branching. Histopathological examination of the lung biopsy specimen showed fungal aggregates morphologically consistent with Mucorales (positive on periodic acid-Schiff [PAS] and Grocott's methenamine silver [GMS] stains). Next-generation sequencing (NGS) of bronchoalveolar lavage fluid (BALF) excluded bacterial and mycobacterial infections. Serial chest CT imaging documented a cavitary lesion in the right lung with multilobar nodules.
TREATMENT: Initially, moxifloxacin was given as empirical anti-infection, and after diagnosis, due to combined renal insufficiency after renal transplantation, gradual incremental amphotericin B liposome (5mg→40mg/d) treatment was given, combined with nebulized amphotericin B, which was adjusted to amphotericin B cholesterol sulfate complex due to persistent elevation of creatinine (peak value of 193μmol/L). After discharge from the hospital, due to recurrent disease, he was switched to long-term consolidation with esaconazole (200mg q8h × 2d sequential 200mg qd), combined with beryllium capsules for renal and lung protection.
CLINICAL OUTCOME: Chest CT showed shrinkage of the cavity after 28 days of treatment, and 2-year follow-up showed significant resorption of the lung lesions, reduction of blood creatinine from 245 μmol/L to 129.10 μmol/L, and maintenance of stable renal function.
TARGET AUDIENCE: Transplant nephrology, endocrinology, infectious diseases, and pulmonology specialists.
SYMPTOMS AND SIGNS: Predominantly dry cough, occasionally accompanied by a small amount of white mucous sputum, accompanied by pharyngeal constriction when coughing violently, profuse sweating and loss of appetite; on examination, the right lung respiratory sounds were coarse, and wet rales were detected, and the rest of the lungs were unremarkable.
DIAGNOSTIC METHODS: Bronchoscopy revealed obstruction by necrotic material in the posterior segment of the right upper lobe. Rapid on-site evaluation (ROSE) demonstrated broad, aseptate hyphae with irregular wide-angle branching. Histopathological examination of the lung biopsy specimen showed fungal aggregates morphologically consistent with Mucorales (positive on periodic acid-Schiff [PAS] and Grocott's methenamine silver [GMS] stains). Next-generation sequencing (NGS) of bronchoalveolar lavage fluid (BALF) excluded bacterial and mycobacterial infections. Serial chest CT imaging documented a cavitary lesion in the right lung with multilobar nodules.
TREATMENT: Initially, moxifloxacin was given as empirical anti-infection, and after diagnosis, due to combined renal insufficiency after renal transplantation, gradual incremental amphotericin B liposome (5mg→40mg/d) treatment was given, combined with nebulized amphotericin B, which was adjusted to amphotericin B cholesterol sulfate complex due to persistent elevation of creatinine (peak value of 193μmol/L). After discharge from the hospital, due to recurrent disease, he was switched to long-term consolidation with esaconazole (200mg q8h × 2d sequential 200mg qd), combined with beryllium capsules for renal and lung protection.
CLINICAL OUTCOME: Chest CT showed shrinkage of the cavity after 28 days of treatment, and 2-year follow-up showed significant resorption of the lung lesions, reduction of blood creatinine from 245 μmol/L to 129.10 μmol/L, and maintenance of stable renal function.
TARGET AUDIENCE: Transplant nephrology, endocrinology, infectious diseases, and pulmonology specialists.