C57-17 After the Storm: Dual Invasive Pulmonary Mucormycosis and Aspergillosis Following Natural Disaster

Abstract Introduction Invasive fungal infections, particularly invasive pulmonary mucormycosis (IPM) and invasive pulmonary aspergillosis (IPA) are rare but life-threatening infections occurring mostly in immunocompromised patients with hematologic malignancies, neutropenia and poorly controlled diabetes.1 Primary pulmonary co-infection is exceedingly rare and associated with poor outcomes due to the aggressive angioinvasive nature of these organisms.1 This case documents the challenges in early diagnosis and treatment in such advanced cases as well as the environmental factors associated with its epidemiology. This highlights the need for heightened clinical suspicion in at-risk geographic regions during and after natural disasters. Presentation A 53-year-old female with a history of poorly controlled type 2 diabetes presented with diabetic ketoacidosis (DKA), shortness of breath, and 1 week of flu-like symptoms. Throughout the hospitalization, the patient’s respiratory status worsened, and she produced increasingly purulent sputum with hemoptysis. Sputum cultures grew as Rhizopus species. Imaging revealed significant infiltrate involvement in the right middle and lower lobes; CTA confirmed consolidations with cavitations. Bronchoscopy demonstrated grossly necrotic tissue, and pathology resulted in numerous fungal organisms morphologically consistent with mucormycosis, along with septate hyphae confirming an Aspergillus co-infection. 4 weeks of IV liposomal amphotericin B (AmB) were initiated. Over these 4 weeks, chest x-rays showed improvement. Nearing the end of her AmB Course, she developed respiratory arrest with evidence of large-volume hemoptysis with aspiration and pulmonary hemorrhage, likely due to the angioinvasive nature of the fungal infection. Discussion This case highlights a rare primary presentation of coinfection with IPM and IPA. IPM alone carries a high mortality rate if not recognized and treated promptly, ranging from 40% to 80% based on co-morbidity and infection site.3 IPM typically develops in patients with profound neutropenia, and graft-versus-host disease, whereas diabetic patients typically present with rhino-orbital disease.3,4 Environmental factors are instrumental in disease propagation, particularly during hydrologic events. Excessive moisture provides appropriate climate conditions for mucormycosis growth.5 Natural events such as hurricanes allow fungal spores to become airborne and disperse across large areas. Building damage caused by the intense winds and water damage can further lead to transmission of fungal spores to the respiratory system and alveolar surfaces.5 This case hopes to raise awareness of the aggressive nature of this infection. With the goal of heightened clinical suspicion, especially in at-risk populations within geographic regions predisposed to such natural events mentioned above. This abstract is funded by: None