Clinical features, management, and outcomes of pulmonary mucormycosis: a decade-long retrospective study from a single center in central China

Background Pulmonary mucormycosis is a life-threatening invasive fungal infection with challenging, often delayed diagnosis and high mortality. This study aims to elucidate the clinical characteristics, diagnostic and therapeutic approaches, and outcomes of pulmonary mucormycosis. Methods This retrospective study enrolled inpatients diagnosed with pulmonary mucormycosis from January 2015 to May 2025. Clinical data were systematically collected and analyzed. Results A total of 16 patients with pulmonary mucormycosis were included in the study. The mean age of the cohort was 52.50 ± 15.02 years, with a male predominance of 68.75%. Diabetes mellitus was identified as the most prevalent underlying condition, affecting 81.25% of patients. The most common clinical symptoms included cough (100%), expectoration (81.25%), fever (68.75%), chest tightness (68.75%), hemoptysis (50%), and chest pain (50%). Common imaging findings comprised nodules <3 cm (87.50%), consolidation (87.50%), ground-glass opacities (75.00%), halo sign (62.50%), and pleural effusion (50.00%). Of the 16 patients, 68.75% exhibited bronchial involvement. Twelve patients were confirmed by histopathology, and one by culture of sterile pleural fluid; the remaining three were classified as probable cases based on clinical and radiological findings, combined with detection of mucorales by mNGS or from non-sterile specimen cultures. The most frequently identified pathogen was Rhizopus microsporus. Systemic antifungal therapy was administered to 13 patients (81.25%), primarily involving a combination of amphotericin B formulations and azoles. Seventy-five percent of patients underwent bronchoscopic debridement or surgical intervention. The 12-month survival rate was 81.25%, with three patients succumbing to sepsis, massive hemoptysis, or respiratory failure, two of whom had extrapulmonary involvement. In this series, favorable outcomes were observed in patients who received combination therapy, particularly bronchoscopic debridement coupled with antifungal medication. Conclusion Pulmonary mucormycosis is highly lethal, frequently associated with bronchial involvement. Bronchoscopy plays a crucial role in both diagnosis and treatment. Combined surgical/bronchoscopic intervention with systemic and local antifungal therapy may contribute to favorable outcomes in this series.