Pulmonary aspergillosis and mucormycosis in an immunocompetent type 1 diabetic patient with past history of healed tuberculosis
Assistant Professor, Grant Government Medical College & Sir J.J. Group of Hospitals, Mumbai, India
B M Warpe Assistant Professor, Grant Government Medical College & Sir J.J. Group of Hospitals, Mumbai, India
Source of Support: None, Conflict of Interest: None
Invasive aspergillus and mucormycosis infection are common in immunocompromised individuals. Endobronchial fungal infections have been reported in the literature, especially in patients with diabetes complicated by diabetic ketoacidosis. The lung co-infection with aspergillus and mucormycosis in an immunocompetent case with a past history of successful anti-tubercular therapy followed by diagnosis of diabetes has not been described in the literature. We report the case of a 47 year old Indian male with type 1 diabetes who was presented with undiagnosed hemoptysis with persistent cough since two years. On work-up the chest X-ray was suggestive of reactivation tuberculosis with bronchiolitis and calcified hilar nodules. HRCT chest revealed an impression of post - Koch sequelae with fungal ball. The lung perfusion and ventilation scan revealed reduced ventilation and perfusion in the apical posterior segment of the upper right lung with a fibro-nodular scar. For definite diagnosis, CT-guided lung biopsy was done from suspected lung ball from apical portion of right lung. The biopsies were subjected to formalin fixed paraffin sectioning which revealed dual fungal colonies of aspergillosis and zygomycosis (mucormycosis). This was later confirmed by special staining with PAS. Thus definite diagnosis for complaints of the patient was obtained using the 'gold standard' diagnostic tool of histopathology. Later the patient responded successfully to anti-fungal therapy with disappearance of his complaints on follow-up.