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Year : 2002  |  Volume : 12  |  Issue : 3  |  Page : 446-447
Mucormycosis : A rare cause of multiple pulmonary nodules


Kasturba Medical College Hospital, Manipal 576 119, India

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How to cite this article:
Lakhkar B N, Rajagopal K V. Mucormycosis : A rare cause of multiple pulmonary nodules. Indian J Radiol Imaging 2002;12:446-7

How to cite this URL:
Lakhkar B N, Rajagopal K V. Mucormycosis : A rare cause of multiple pulmonary nodules. Indian J Radiol Imaging [serial online] 2002 [cited 2020 Aug 8];12:446-7. Available from: http://www.ijri.org/text.asp?2002/12/3/446/28510
Sir,

A seventy-two year old female, diabetic since twenty years presented with a history of fever since 15 days. Chest radiograph showed confluent opacities in bilateral lower lung fields and few faint nodular opacities in the rest of the lung fields [Figure - 1]. CT revealed well defined multiple nodular opacities throughout both lung fields with conglomerate nodular opacities in the basal segments of the bilateral lower lobes [Figure - 2]. There were multiple enlarged right paratracheal lymph-nodes. Based on the CT findings a diagnosis of multiple secondary deposits in the lung was made. A CT guided FNAC from one of the nodules showed mucormycosis. The smear showed the typical non-septated right angle branching-shaped hyphae within the lung tissue. No malignant cells were seen in the smear. Subsequent open lung biopsy also demonstrated organisms in the granuloma.

Mucor belongs to a unique group of fungi within the class Zygomycetes and is generally a noninvasive saprophyte in the normal host. In the face of pre-existing disease, however, mucormycosis can become a serious and usually a fatal invader. Rhinocerebral disease involving the paranasal sinuses, nasal cavity and palate, which may extend into the central nervous system, is the most common manifestation. Pulmonary involvement has been uncommon, but the incidence has been increasingly recognized especially in patients with lymphoma, leukemia or diabetes. Of the patients who die with disseminated mucormycosis, 80-90% have pulmonary involvement [1]. Patients with lung involvement present with cough, fever, pleuritic chest pain and often haemorrhagic sputum production. Our patient only presented with fever.

In a recent review of imaging findings in 32 cases of mucormycosis, two thirds of the patients had consolidation as a main finding. Forty-one percent of the patients had cavitation within pulmonary consolidation or masses. Three patients (9%) had solitary pulmonary nodule. Only two patients (6%) showed multiple pulmonary nodules. Hilar and mediastinal lymphadenopathy was observed in nine percent each [2]. Other radiographic manifestations include multifocal consolidation, an "air crescent sign" whenever a pulmonary infarct results from vascular invasion and rarely pleural effusion. Our patient had multiple pulmonary nodules with mediastinal lymphadenopathy.

Jamadar DA et al [3], described the CT appearance in eight cases of pulmonary zygomycosis. In their study lesions predominantly involved the upper lobes (84%), especially the posterior segment (93%). They concluded that, in the appropriate clinical circumstance, nodules or mass-like or wedge shaped consolidation, especially posteriorly in the upper lobes should suggest mucormycosis. In our case nodules were distributed in both lung fields predominantly involving the lower lobes

In the present case, CT showed multiple well-defined nodules throughout both the lung fields. There were some conglomerate nodules in bilateral basal segments. Diagnosis was initially established by FNAC of the lung nodule. Kutsuzawa T, et al . [4] have reported a similar case with multiple nodules in the lungs proved to be Mucormycosis on open lung biopsy. Their patient did not have any predisposing factors.

There are no definitive roentgen criteria for diagnosing pulmonary mucormycosis, but the radiologist should be aware of the clinical setting for opportunistic infection, because certain clues on chest radiograph and CT may enable him to suggest mucormycosis as a possible etiology. Pulmonary mucormycosis should be considered in the differential diagnosis in a patient with multiple nodules in the lung, especially in a patient predisposed to this disease.

 
   References Top

1.Chandler FW, Watts JC. Fungal infections. In: Dial DH, Hammar SP, Eds. Pulmonary pathology. New york: Springer-Verlag, 1988:228-31.  Back to cited text no. 1    
2.McAdams HP, Rosado de Christenson M, Strollo DC, Patz EF Jr. Pulmonary mucormycosis: Radiologic findings in 32 cases AJR. 1997; 168 {6}: 1541-8  Back to cited text no. 2    
3.Jamadar DA, Kazerooni EA, Daly BD, White CS, Gross BH. Pulmonary zygomycosis. J. Computer Assist Tomogr 1995; 195 (5): 733-8.  Back to cited text no. 3    
4.Kutsuzawa T, Matsuura Y, Sakuma H, Narimatsu H, Ohta Y, Yamabayashi H. Multiple pulmonary nodules caused by zygomycosis in a patient without predisposing factors. Jpn J Med 1991; 30 (5): 435-7  Back to cited text no. 4    

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Correspondence Address:
B N Lakhkar
Kasturba Medical College Hospital, Manipal 576 119
India
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