Abstract Introduction Dual pulmonary fungal infections caused by Aspergillus and Mucorales are uncommon but often fatal, particularly in immunocompromised patients such as those with uncontrolled diabetes mellitus. Both pathogens share overlapping clinical and radiologic features, making early diagnosis challenging. Prompt identification and initiation of targeted antifungal therapy are crucial to improving survival. Case Presentation A 49-year-old man with a 4-year history of poorly controlled diabetes mellitus presented with low-grade fever, cough, and progressive dyspnea of six weeks’ duration. Physical examination revealed tachypnea with coarse crackles over the right hemithorax. Chest radiograph showed heterogeneous opacities in the right upper and middle zones with blunting of the costophrenic angle. Computed tomography (CT) of the chest demonstrated right upper, middle, and lower lobe consolidation with nodular infiltrates in the contralateral lung. Laboratory evaluation revealed leukocytosis (28,000 cells/mm³; 88% neutrophils) and markedly elevated blood glucose levels. HIV testing and blood cultures were negative. Flexible bronchoscopy revealed cheesy exudates adherent to the right main bronchus extending into the lower lobe bronchus. Bronchoalveolar lavage (BAL) microscopy showed both septate and aseptate fungal hyphae, consistent with Aspergillus and Mucorales species. Transbronchial lung biopsy (TBLB) confirmed dual fungal invasion. The patient was immediately initiated on intravenous liposomal amphotericin B. Despite aggressive antifungal therapy and supportive management, he developed progressive respiratory failure and succumbed within days of diagnosis. Discussion and Novelty Concurrent infection with Aspergillus and Mucorales is rarely reported. Diabetes mellitus predisposes to both infections by impairing neutrophil function and promoting fungal proliferation in hyperglycemic, acidic environments. Diagnosis requires a high index of suspicion, histopathological confirmation, and early antifungal initiation. Amphotericin B remains the cornerstone of therapy; however, mortality remains high, particularly when surgical resection is not feasible. This case emphasizes the importance of multidisciplinary coordination among pulmonology, microbiology, and infectious disease teams for timely diagnosis and intervention. Conclusion Dual pulmonary fungal infections can present as rapidly progressive pneumonia in diabetic patients. Early bronchoscopy and tissue sampling are essential for diagnosis. Prompt antifungal therapy, strict glycemic control, and multidisciplinary management are critical for improving outcomes. This abstract is funded by: none
Rahman et al. (Fri,) studied this question.