CASE REPORT article
Front. Med.
Sec. Pulmonary Medicine
Volume 12 - 2025 | doi: 10.3389/fmed.2025.1687285
Case Report: Pulmonary Coinfection with Rhizopus Microsporus and Streptococcus Agalactiae in a Patient with New-Onset Uncontrolled Diabetes: Successful Diagnosis and Medical Management
Provisionally accepted
- The First Affiliated Hospital of Dalian Medical University, Dalian, China
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Background: We report an unusual case of pulmonary mucormycosis caused by Rhizopus microsporus with co-infection by Streptococcus agalactiae in a patient with newly diagnosed uncontrolled diabetes. Unlike most previous cases, the current case was successfully treated without surgery or amphotericin B. Targeted next-generation sequencing (tNGS) enabled early detection of the pathogen and prompted treatment. Case presentation: A 50-year-old man presented with fever, weakness, and a cavity surrounded by ground-glass opacities. Laboratory examination detected previously uncontrolled diabetes mellitus (HbA1c 11.4%). tNGS of bronchoalveolar lavage fluid detected Rhizopus microsporus and Streptococcus agalactiae. The patient was treated with isavuconazole monotherapy, targeted antibiotics, insulin therapy, and nutritional support. His condition improved over time, with clinical recovery and radiological improvement without needing surgery. Conclusion: This case shows that non-surgical treatment of cavitary pulmonary mucormycosis can be achieved in selected cases. Early initiation of tNGS and isavuconazole-based treatment offers a less invasive, efficient approach for treating complex pulmonary infections in immunocompromised patients. Early suspicion of mucormycosis in high-risk diabetics with persistent infections is essential to timely intervention.
Keywords: Pulmonary mucormycosis, Uncontrolled diabetes, Rhizopus microsporus, Isavuconazole, Targeted next-generation sequencing (TNGS)
Received: 17 Aug 2025; Accepted: 16 Oct 2025.
Copyright: © 2025 Al-waqeerah, Guo, BASHAH, Luo, Ghaleb, Chen and Gao. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Lili Gao, gaolili111@dmu.edu.cn
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