Three cases report of pulmonary mucormycosis with review of the literature

Zhengyang Zhang¹Min Wang^2*

• ¹Shandong University of Traditional Chinese Medicine, Jinan, China
• ²Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong Province, China

Abstract：Pulmonary mucormycosis (PM), an invasive and life-threatening fungal infection, predominantly affects immunocompromised individuals.This study systematically analyzed the disease through three case reports and a literature review.Case 1 involved a patient with type 1 diabetes mellitus diagnosed via bronchoscopic histopathology, who succumbed despite combined therapy with oral isavuconazole, nebulized amphotericin B, and intravenous amphotericin B cholesteryl sulfate complex.Case 2, a follicular non-Hodgkin lymphoma patient with concurrent COVID-19 infection, was confirmed by metagenomic next-generation sequencing (mNGS) of bronchoalveolar lavage fluid and achieved clinical improvement following sequential intravenous voriconazole, amphotericin B cholesteryl sulfate complex, and oral isavuconazole.Case 3, diagnosed with mNGS in a lung cancer patient with chronic obstructive pulmonary disease, showed poor therapeutic response to combined intravenous voriconazole, amphotericin B cholesteryl sulfate complex, and oral isavuconazole, resulted in fatal outcomes.Literature synthesis revealed mortality rates of 28.3%with antifungal monotherapy versus 23.7% when antifungal monotherapy was combined with bronchoscopic intervention, the mortality rate for antifungal-surgical combination therapy was 9%. Notably, all 13 patients receiving multimodal therapy (antifungals, bronchoscopy, and surgery) survived. These findings underscore that,combination therapy integrating pharmacotherapy, bronchoscopic intervention, and surgical resection demonstrated significantly superior survival outcomes compared to monotherapy.