CLINICAL CHARACTERISTICS AND PROGNOSIS OF CHRONIC PULMONARY ASPERGILLOSIS IN PATIENTS WITH PREVIOUS OR ACTIVE TUBERCULOSIS

mucormycosis is an life-threatening opportunistic fungal infection which affects immunocompromised patients such as diabetes, recipients of stem cell or organ transplant, and has worse outcomes in those with hematologic malignancy or neutropenia.Methods: A 35 years old male patient with uncontrolled type II Diabemellitus presented to casualty with complaints of cough associated with thick dark brownish sputum for 1 month, fever, loss of appetite and weight since 15 days.His vitals were stable at the time of admission.Chest auscultation revealed diminished vesicular breath sounds heard in right infraclavicular and suprascapular area.Complete blood count showed leucocytosis with neutrophilic predominance.He also had hyponatremia and hypokalaemia.Chest x-ray showed large irregular thick walled cavity in right mid and lower zone.CT thorax revealed central bronchopleural fistula involving right main bronchus with collapse and consolidation involving right middle and lower lobe.Patient underwent diagnostic bronchoscope which showed distorted right secondary carina and there was a large communication in right main bronchus extending to pleural space with thick brownish collection.Right upper lobe bronchial mucosa was unhealthy, covered with thick brownish slough.Results: Bronchoalveolar lavage KOH smear and Transbronchial lung biopsy showed fungal organisms with broad aseptate hyphae suggestive of mucormycosis and he was started on intravenous amphotericin deoxycholate 50mg.Right pneumonectomy was performed in view of large BPF. Conclusion:We evidenced a positive clinical outcome in a poorly controlled diabetic state with early surgical resection and a combination of antifungals.It highlights the importance of the early diagnosis, treatment and timely surgical debridement for the therapy of mucormycosis.