Abstract Introduction Pulmonary mucormycosis is a rare and life-threatening fungal infection primarily affecting immunocompromised individuals, transmitted typically through inhalation of spores. Risk factors include diabetes, hematologic malignancies, and immunosuppressive therapies like ibrutinib. Its angioinvasive nature causes thrombosis, infarction, and necrosis. We present a case of rapidly progressive pulmonary mucormycosis in an immunocompromised patient. Case Presentation A 75-year-old male with type 2 diabetes, chronic lymphocytic leukemia on ibrutinib, and COPD presented with worsening dyspnea and cough. Workup showed leukocytosis of 16.6 and an elevated D-dimer level. CT chest revealed right-sided consolidation with bilateral pleural effusions. Cefepime and vancomycin were started for presumed pneumonia. Thoracentesis yielded transudative, bloody aspirate; cultures were negative. Bronchoscopy revealed right middle lobe obstruction with dense debris. Endobronchial biopsies, transbronchial lymph node aspirates, and bronchoalveolar lavage (BAL) were obtained. BAL cytology was negative for malignant cells. Initial fungal stains were negative however fungal cultures later grew Zygomycetes. Liposomal amphotericin B was initiated with the confirmation of mucormycosis. The patient experienced a PEA arrest requiring CPR. Post return of spontaneous circulation, he was intubated and required vasopressors. MRI brain showed a subacute infarct likely from hypoperfusion. Follow-up imaging showed near-complete right lung opacification, new left lower lobe nodules, and mediastinal adenopathy. Despite antifungal treatment and intensive care, his condition declined. After a multidisciplinary discussion, patient was transitioned to comfort focused care and he passed peacefully. Discussion This case highlights the fulminant course of pulmonary mucormycosis in a patient on ibrutinib. Mortality can reach up to 50% in localized and 90% in disseminated disease. Even with a timely bronchoscopy, definitive diagnosis relied on fungal culture. Diagnosis is very challenging due to nonspecific symptoms and poor early test sensitivity. Moreover, Ibrutinib impairs phagocytosis and neutrophil function, increasing susceptibility to mucormycosis. Despite antifungal therapy, rapid disease progression occurs due to angioinvasion and immunosuppression. Pulmonary mucormycosis has a high mortality rate in immunocompromised patients. Early clinical suspicion, timely empiric antifungal therapy, and diagnostic efforts are critical to improving outcomes. This abstract is funded by: None
Christian et al. (Fri,) studied this question.