Bronchoscopy guided resection of endobronchial mucormycosis in a renal transplant patient with chronic graft rejection: A non-surgical approach using bronchoscopy guided intervention as salvage therapy

Pulmonary mucormycosis is a rare but rapidly progressive fungal infection commonly associated with diabetes mellitus, hematologic malignancies, and solid-organ transplants. Prompt diagnosis is essential given the infection's invasive nature and the likelihood of dissemination. The standard treatment typically involves surgical resection and systemic antifungal therapy, specifically liposomal amphotericin B, along with correction of the underlying risk factors. We present a 53-year-old male with diabetes, hypertension, end-stage renal disease (ESRD) on maintenance hemodialysis (MHD) and chronic graft rejection following renal transplantation who presented with progressive respiratory symptoms. Initially treated as community-acquired pneumonia, his clinical condition progressively worsened despite appropriate antimicrobial therapy. Subsequent fibre-optic bronchoscopy (FOB) revealed a friable endobronchial mass with a spongiform appearance completely occluding the left mainstem bronchus and extending into the segmental bronchi, including upper, middle, and lower lobes. Complete resection of the endobronchial lesion was achieved using bronchoscopy-guided techniques, including cryoablation, argon plasma coagulation, and snare-forceps excision, thereby avoiding high-risk surgical intervention. Histopathological examination was consistent with invasive pulmonary mucormycosis. Following bronchoscopy, treatment with liposomal amphotericin B and oral posaconazole for parenchymal disease resulted in significant clinical and radiological improvement. This case highlights the promising role of advanced bronchoscopy-guided interventions as an adjunct to both diagnostic and therapeutic modalities in high-risk cases of pulmonary mucormycosis with an endobronchial component, particularly when conventional surgical approaches are not feasible due to life-threatening post-surgical complications and comorbidities.