Prolonged bronchoscopic management after relief of severe necrotic tracheobronchial obstruction in disseminated mucormycosis: a case report.
- 1Department of Respiratory and Critical Care Medicine, Emergency General Hospital, Beijing, China.
- 2Department of Medicine Solna, Karolinska Institutet, and Center for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden.
Abstract
The airway course after relief of severe necrotic tracheobronchial obstruction in disseminated mucormycosis remains poorly described. We report a 53-year-old man with poorly controlled diabetes mellitus who developed disseminated pulmonary and cerebral mucormycosis caused by Rhizopus species. Despite initial treatment, extensive necrotic tracheobronchial obstruction progressed, with complete occlusion of the right middle lobe bronchus and multilevel obstruction of the left upper lobe and right lower lobe bronchi. Systemic antifungal therapy and repeated bronchoscopic interventions, including necrotic tissue debridement and local amphotericin B instillation were associated with progressive clearance of necrosis, restoration of airway patency, and improvement of pulmonary and cerebral disease. Bronchoscopic interventions were initially performed two to three times weekly, with local amphotericin B at 25-35 mg per session. As previously occluded bronchi reopened, access to additional affected bronchi expanded the treatment area, the dose increased to 45-50 mg per session to cover additional affected areas, while intervention frequency. decreased to weekly. Further improvement allowed reduction of the local dose to 20 mg per session and less frequent interventions. Systemic antifungal therapy was discontinued at Month 12, but intermittent bronchoscopic interventions, including local amphotericin B instillation, continued through Month 25 because of the severity of the preceding endobronchial disease, persistent bronchial narrowing, and impaired secretion clearance. No recurrent extensive necrotic obstruction was observed. This case suggests a potential adjunctive role for bronchoscopic amphotericin B in selected patients with severe necrotic tracheobronchial mucormycosis and illustrates the need for continued airway surveillance and secretion clearance after relief of obstruction.
Related
- Tracheobronchial pen cap and pen nib foreign body aspiration in 32 children: clinical features, CT findings, and bronchoscopic management
- Low-temperature plasma radiofrequency ablation combined with multimodal bronchoscopic interventions for tracheobronchial amyloidosis-induced airway stenosis: a case report and literature review.
- A Fatal Case of Disseminated Mucormycosis in a Patient Shortly after Starting Treatment against Malignant Lymphoma
- Giant Abdominal Mass Caused by Disseminated Hepatic Hydatid Disease Leading to Acute Intestinal Obstruction
- Intrabiliary Rupture of a Hepatic Hydatid Cyst Causing Mechanical Biliary Obstruction: A Case Report of Endoscopic Management With a Self-Expandable Metal Stent
BibTeX
@article{zhang2026prolonged,
title = {{Prolonged bronchoscopic management after relief of severe necrotic tracheobronchial obstruction in disseminated mucormycosis: a case report.}},
author = {Jieli Zhang and Yongping Gao and Fang Qin and Peng Zhang and Jing Gao and Yunzhi Zhou},
journal = {Respiratory medicine case reports},
year = {2026},
month = oct,
doi = {10.1016/j.rmcr.2026.102526},
url = {https://europepmc.org/article/MED/42997491},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Prolonged bronchoscopic management after relief of severe necrotic tracheobronchial obstruction in disseminated mucormycosis: a case report.
AU - Jieli Zhang
AU - Yongping Gao
AU - Fang Qin
AU - Peng Zhang
AU - Jing Gao
AU - Yunzhi Zhou
PY - 2026
DA - 2026/10/28
JO - Respiratory medicine case reports
DO - 10.1016/j.rmcr.2026.102526
UR - https://europepmc.org/article/MED/42997491
AB - The airway course after relief of severe necrotic tracheobronchial obstruction in disseminated mucormycosis remains poorly described. We report a 53-year-old man with poorly controlled diabetes mellitus who developed disseminated pulmonary and cerebral mucormycosis caused by Rhizopus species. Despite initial treatment, extensive necrotic tracheobronchial obstruction progressed, with complete occlusion of the right middle lobe bronchus and multilevel obstruction of the left upper lobe and right lower lobe bronchi. Systemic antifungal therapy and repeated bronchoscopic interventions, including necrotic tissue debridement and local amphotericin B instillation were associated with progressive clearance of necrosis, restoration of airway patency, and improvement of pulmonary and cerebral disease. Bronchoscopic interventions were initially performed two to three times weekly, with local amphotericin B at 25-35 mg per session. As previously occluded bronchi reopened, access to additional affected bronchi expanded the treatment area, the dose increased to 45-50 mg per session to cover additional affected areas, while intervention frequency. decreased to weekly. Further improvement allowed reduction of the local dose to 20 mg per session and less frequent interventions. Systemic antifungal therapy was discontinued at Month 12, but intermittent bronchoscopic interventions, including local amphotericin B instillation, continued through Month 25 because of the severity of the preceding endobronchial disease, persistent bronchial narrowing, and impaired secretion clearance. No recurrent extensive necrotic obstruction was observed. This case suggests a potential adjunctive role for bronchoscopic amphotericin B in selected patients with severe necrotic tracheobronchial mucormycosis and illustrates the need for continued airway surveillance and secretion clearance after relief of obstruction.
SN - 2213-0071
ER -